Sequential Therapy for Eradication of Helicobacter pylori: A New Guiding Light or a False Dawn?
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Helicobacter pylori-related diseases are a major global problem, and currently recommended regimens are achieving disappointing eradication rates. Trials of sequential therapy have suggested that it is superior to standard proton pump inhibitor (PPI)-based triple therapy. Gatta et al. report a rigorous systematic review that identified 13 trials evaluating 3,271 patients. Their data suggest that the sequential therapy achieves a 12% better absolute eradication rate than the standard PPI triple therapy. There is no evidence of publication bias or other small study effects. The quality of all but one of the studies, however, is poor; therefore, this limits the confidence that can be placed in these data. Most of the studies were conducted in Italy, and there is evidence that the efficacy of sequential therapy in Asia is more disappointing, emphasizing the need to study this regimen in North America and other settings. Sequential therapy is not ready for prime time, but it is a promising approach that merits further study.
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