Eradication And Safety Of Sequential Therapy And Standard Triple Therapy For Helicobacter Pylori Infection In Children:A Meta-analysis

Objective: To analyze the existing study reports by meta-analysis to evaluate the differences in the eradication rate and adverse reactions of Helicobacter pylori infection in children with SEQ and STT.Methods: The search methods were computer search and manual search.Computer search range:(1)Cochrane Library(1988-2017.12);(2)Pubmed Data(1966-2017.12);(3)Embase(1974-2017.12)(4)Web of Science(1990-2017.12);(5)CBMdisc(1978-2017.12);(6)CNKI(1984-2017.12);(7)VIP(1989-2017.12);(8)Wangfang Data(1980-2017.12).Cross-search between databases to retrieve relevant literature as comprehensively as possible to avoid missing.Manually searched for content including various medical core journals and other related reports.Strictly follow the principles of inclusion and exclusion criteria,read and screen the relevant literature reports,and extract and collate the final literature,and use the Cochrane Collaboration meta-analysis software Review manager 5.3 for analysis.The combined effect size uses the risk difference(RD).The heterogeneity test of each literature uses the χ2 test.The model selects the fixed effect model or the random effect model according to the heterogeneity.The main evaluation indicators of this study include:(1)eradication rate;(2)adverse reactions.Secondary evaluation indicators We mainly used subgroup analysis methods,including:(1)clinical efficiency;(2)geographic location;(3)publication time;(4)STT treatment length;(5)participants health status;(6)nitroimidazole type.Results: Study inclusion results: Through the inclusion of criteria and exclusion criteria for literature screening,28 articles of standard literature were finally included,with a total of 3374 patients.The average age of Hp patients was about 8 years,which boys were accounted for about 58.4%.There were 5 studies,which was 10 days of SEQ and 7 days of STT;24 studies was 10 days SEQ and 10 days of STT;4 studies was 10 days of SEQ and 14 days of STT;14 days of SEQ and 7 days of STT was only 1 study;10 days of SEQ or STT was sputum quadruple therapy;10/14 days of SEQ or STT was combined with probiotics;10 days SEQ or STT used furazolidone was only 1 study.The SEQ was used a total of 10 studies,which was "amoxicillin + PPI " in the first 5 days,"clarithromycin + PPI + metronidazole" in the last 5 days;17 studies of the SEQ was used "amoxicillin + PPI" in the first 5 days,clarithromycin + PPI + tinidazole" in the last 5 days.There were 22 studies of STT,which was used "amoxicillin + clarithromycin + PPI";2 studies about STT was used "methineazole + clarithromycin + PPI ".Meta analysis results: Main outcome measures:(1)SEQ showed better Hp eradication rate than STT,the difference was statistically significant(RD=0.16,95% CI: 0.13-0.19),and the inverted funnel plot was basically symmetrical,indicating that publication bias was better controlled;(2)There was no significant difference in the incidence of adverse reactions between SEQ and STT,the difference was not statistically significant(RD=0.00,95% CI:-0.03-0.03),and the inverted funnel plot was basically symmetrical,indicating that publication bias was better controlled.Secondary outcome measures:(1)SEQ showed better clinical efficiency than STT,and the difference was statistically significant(RD=0.12,95% CI: 0.08-0.15);(2)The Hp eradication effect of SEQ was better than STT in China,the difference was statistically significant(RD=0.16,95% CI: 0.12-0.19);the Hp eradication effect of SEQ was better than STT in foreign countries(mainly in Europe),the difference was statistically significant(RD=0.16,95% CI: 0.09-0.23);(3)SEQ showed better eradication effect than STT before 2012,the difference was statistically significant(RD=0.07,95% CI: 0.01-0.12);after 2012(including2012),SEQ showed better eradication effect than STT,the difference was statistically significant(RD=0.17,95% CI: 0.14-0.21);(4)SEQ showed better eradication effect than the 7-day STT,the difference was statistically significant(RD=0.14,95% CI:0.06-0.21);SEQ showed better eradication than standard 10-days STT,the difference was statistically significant(RD=0.18,95% CI: 0.14-0.21);There was no significant difference in the eradication effect between SEQ and 14-days STT,and the difference was not statistically significant(RD=0.02,95% CI:-0.05-0.09);(5)The SEQ of NUD patients showed better eradication effect than STT,the difference was statistically significant(RD=0.15,95% CI: 0.11-0.20);the SEQ of PUD patients showed better eradication effect than STT,the difference was statistically significant(RD=0.19,95% CI: 0.13-0.24);(6)SEQ using metronidazole showed better eradication effect than STT,the difference was statistically significant(RD=0.14,95% CI: 0.10-0.18);SEQ using tinidazole showed better eradication effect than STT,the difference was statistically significant(RD=0.11,95% CI: 0.13-0.21).All the literatures were RCTs,which was 21.4% of the literatures did not explain the process of clear randomized allocation;only 11.3% of the literatures were uesd blinding the results;most of the literatures did not blind patients and doctors;9.8% of the literatures did not report statistical results of incomplete results,so there are bias risks such as measurement and implementation offset in this study.Conclusions:(1)Meta-analysis of the study showed that SEQ was better efficacy in eradicating Hp than STT.(2)Meta-analysis of the study was no significant difference in the incidence of adverse reactions between SEQ and STT.