Treatment of Helicobacter pylori in the Arab world: a systematic review and network meta-analysis

Purpose: We conducted a systematic review and network meta-analysis (NMA) to estimate the efficacy of Helicobacter pylori (H. pylori) treatment strategies in Arab countries.Methods: We searched electronic databases from inception to July 18, 2020, using boolean operators. Search terms were (Helicobacter pylori R H. pylori OR pylori OR helicobacter). The risk of bias was assessed using Cochrane risk of bias tool. Retrieved articles were screened, and relevant data were extracted. We used R programming software to analyze extracted data.Results: Fifty-four articles (n= 7829 patients) were included in the NMA. Pooled analysis demonstrated that adjuvant therapy (standard triple or sequential therapy plus another adjuvant drug) was the best treatment with higher odds of eradication rate [OR= 6.42, 95% CI (1.37: 30.05), P-score= 0.21]. In naïve population, quinolones-based therapy (QBT) and sequential therapy (SQT) were associated with higher eradication rates than other regimens [OR= 1.94, 95% CI (1.19: 3.16), P score=0.19] and [OR= 1.66, 95% CI (1.10: 2.50), P score=0.33]. In experienced population, all medication showed a non-significant difference in eradication rates when compared to triple therapy (TT); QBT (OR= 1.86, 95% CI, [0.15, 22.88], p=0.44) and SQT (OR= 1.49, 95% CI, [0.13, 17.59], p=0.52). Conclusion: Our findings suggested that QBT and SQT therapies were the most effective regimens for eradicating H. pylori in naïve patients in the Arab countries. In experienced patients, all medication showed a non-significant difference in eradication rates.