Meta-analysis:: proton pump inhibitors vs. H2-receptor antagonists -: their efficacy with antibiotics in Helicobacter pylori eradication

Background: It is unknown whether proton pump inhibitors are superior to H-2-receptor antagonists in Helicobacter pylori eradication regimens. Aim: To perform a meta-analysis comparing the efficacy of both antisecretors when co-prescribed with antibiotics. Methods: Randomized clinical trials comparing proton pump inhibitors vs. H-2-receptor antagonists with the same antibiotics were selected. Data sources included PubMed, the Cochrane Controlled Trials Register and abstracts from congresses up to January 2002. A meta-analysis was performed by combining the odds ratios. Results: Twenty studies fulfilled the inclusion criteria. In the intention-to-treat analysis, the mean eradication rates with proton pump inhibitors and H-2-receptor antagonists plus antibiotics were 74% [95% confidence interval (CI), 71-76%] and 69% (95% CI, 66-71%), respectively. The odds ratio for this comparison was 1.31 (95% CI, 1.09-1.58). The number needed to treat with proton pump inhibitors to achieve eradication success, compared with H-2-receptor antagonists, was 25. When studies prescribing very high doses of H-2-receptor antagonists (two of the outliers) were excluded, the odds ratio (for proton pump inhibitors vs. H-2-receptor antagonists) increased to 1.37, the number needed to treat decreased to 20 and the heterogeneity between the studies decreased. Conclusions: Overall, proton pump inhibitors are more effective than H-2-receptor antagonists when prescribed at usual doses with antibiotics to eradicate H. pylori infection.