N. Vakil

Sequential therapy or triple therapy for Helicobacter pylori infection: systematic review and meta-analysis of randomized controlled trials in adults and children.

OBJECTIVES:Eradication rates with triple therapy (TT) for Helicobacter pylori infection have declined to unacceptable levels. Sequential therapy (ST) is a novel treatment that has shown promise in several controlled trials. Our aim was to assess the efficacy of ST in adults and children compared with that of TT by performing a systematic review and meta-analysis.METHODS:We performed an electronic search of the following: Cochrane Trial Register (until Issue 4, 2008), MEDLINE (1966 to 21 October 2008), EMBASE (1980 to 21 October 2008), and abstracts from the major US, European, and Asian gastroenterology conferences. Randomized controlled trials (RCTs) and controlled clinical trials with a parallel group design comparing the ST with a TT lasting at least 7 days were used.RESULTS:Ten RCTs enrolled 3,006 adult patients and the odds ratio (OR) for eradication of H. pylori with ST compared with TT was 2.99 (95% confidence interval (CI): 2.47–3.62), giving a number needed to treat (NNT) of 6 (95% CI: 5–7) favoring ST. There was no publication bias. The OR for eradication with ST compared with 10-day TT was 2.92 (95% CI: 1.95–4.38), yielding an NNT of 8 (95% CI: 6–12), favoring ST. In patients with clarithromycin resistance, the OR for eradication with ST was 10.21 (95% CI: 3.01–34.58) compared with TT, but the numbers studied are small. Three RCTs enrolled 260 children and adolescents, and the OR for eradication was 1.98 (95% CI: 0.96–4.07). There was no difference in the rate of side effects between the ST and the TT (OR, 1.01; 95% CI: 0.78–1.30).CONCLUSIONS:ST appears to be better than TT in the eradication of H. pylori. This is a promising therapy, but further trials are needed in other European countries and North America before it can be recommended as a first-line treatment.

Efficacy of 5-asa in the Treatment of Colonic Diverticular Disease

Objective To assess the therapeutic efficacy of 5-aminosalicylic acid (5-ASA) in patients with colonic diverticular disease performing a systematic review of the literature. Data Sources Cochrane Trial Register (until Issue 4, 2008), Medical Literature Analysis and Retrieval System Online (1966 to October 1, 2008), Excerpta Medica Database (1980 to October 1, 2008), and abstracts from the major US, European, and Asian gastroenterology conferences. Expert opinions sought and reference lists of identified studies and any relevant published reviews checked. Study Selection Randomized controlled trial (RCT) or a controlled clinical trial with a parallel group design using 5-ASA as 1 treatment arm. Results Six RCTs enrolling 818 patients were found: 3 were performed in patients with uncomplicated diverticulitis, and the remaining in patients with symptomatic uncomplicated diverticular disease. The results of these studies showed that patients treated with 5-ASA had significantly better outcomes and that also mesalazine scheduled daily was superior to cyclic administration to prevent relapse of diverticular disease. However, several of these studies have not included an endoscopy at the start of the study and when patients had recurrences. Conclusions From this systematic review, it seems that 5-ASAs may have a role in patients with colonic diverticular disease. However, high-quality well-designed RCTs are necessary to confirm these initial observations.

OC.06.3 EFFICACY OF SEQUENTIAL THERAPY IN NEVER BEEN TREATED HELICOBACTER PYLORI PATIENTS WITH MULTI-RESISTANT STRAINS

(2183) subjects reported previous eradication therapy. BMI was ≤18 in 188 (4%), ≥18.1-≤25 in 2322 (50%), ≥25.1-≤30 in 1576 (35%) and ≥30.1 in the remaining 514 (11%) of the cases. H. pylori infection was detected in 1892 (40.7%) with a progressive increasing trend according to BMI (≤18: 36%; ≥18.1-≤25: 34%, ≥25.1-≤30: 46% and ≥30.1: 56%; p 50 years). Conclusions: H. pylori infection is significantly more frequent in obese than in normal weight individuals, irrespective of sex and age. Further studies, aiming to explore the role of hormones involved in the homeostasis food intake/satiety, such as ghrelin and obestatin, in linking H. pylori infection and obesity are needed.