Probiotics-containing quadruple therapy Versus Bismuth Quadruple Therapy as a Rescue Regimen for the Eradication of Helicobacter Pylori Infection:A Meta-analysis

OBJECTIVE To systematically review the efficacy and safety of probiotics containing quadruple therapy(PQT) as a rescue regimen for the eradication of Helicobacter pylori (Hp) infection. METHODS To search clinical trials about PQT versus bismuth quadruple therapy(BQT) as a rescue regimen for the eradication of Hp infection from inception to October 2016. Two reviewers independently screened literature, extracted data, and assessed the methodological quality of included studies by revised Jadad scale. The meta-analysis was performed by RevMan5.3 software. RESULTS A total of 9 clinical trials containing 875 patients were finally included. The results of meta-analysis showed that:according to ITT analysis, the Hp eradication rate of PQT as a rescue regimen was higher than that of BQT, but the difference was not statistically significant (RR=1.03, 95%CI:0.97-1.10, P=0.36); according to PP analysis, the Hp eradication rate of PQT versus BQT was considerable, but the difference was not statistically significant (RR=1.00, 95%CI:0.94-1.07, P=0.90). The incidence of adverse reactions of PQT was significantly lower than that of the control group, and the difference was statistically significant (RR=0.31, 95%CI:0.23-0.41, P<0.000 01). CONCLUSION Compared with BQT, the incidence of adverse reactions of PQT is lower, but there is no significant difference in Hp eradication rate between the two therapies. More large-scale and high-quality studies are needed to confirm the above conclusions.