PPI‐amoxicillin dual therapy for Helicobacter pylori infection: An update based on a systematic review and meta‐analysis

Background and Aims The efficacy of PPI‐amoxicillin dual therapy (high‐dose dual therapy) in the eradication of Helicobacter pylori is controversial. We aimed to investigate whether PPI‐amoxicillin dual therapy is effective. Methods We searched several publication databases for randomized controlled trials (RCTs) that compared PPI‐amoxicillin dual therapy with controls up to March 2019. Meta‐analyses of eradication rates were performed using random‐effects models. Results Data from twelve RCTs including 2249 patients suggested that PPI‐amoxicillin dual therapy and the current mainstream guidelines‐recommended therapies achieved similar efficacy (83.2% vs 85.3%, risk ratio [RR]: 1.00, 95% CI 0.97‐1.03, intention‐to‐treat analysis), (87.5% vs 90.1%, RR: 0.98, 95% CI 0.95‐1.02, per‐protocol analysis), and compliance (94.3% vs 93.5%, RR: 1.11, 95% CI 0.78‐1.59), but side effects were less likely in the dual therapy (12.9% vs 28.0%, RR: 0.53, 95% CI 0.37‐0.76). Further subgroup analyses showed that the seven RCTs (1302 patients) that reported antimicrobial susceptibility test results also showed that PPI‐amoxicillin dual therapy and the current guidelines‐recommended therapies achieved similar efficacy, and PPI‐amoxicillin dual therapy was as effective for rescue therapy (RR: 0.97, 95% CI 0.89‐1.05) as for first‐line treatment (RR: 0.97, 95% CI 0.93‐1.02). Conclusions Compared with the current mainstream guidelines‐recommended therapies, PPI‐amoxicillin dual therapy has the same efficacy and compliance, and generally PPI‐amoxicillin dual therapy causes fewer side effects.