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

Summary Background : It is unknown whether proton pump inhibitors are superior to H2‐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. H2‐receptor antagonists with the same antibiotics were selected. Data sources included PubMed, the Cochrane Controlled Trials Register and s 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 H2‐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 H2‐receptor antagonists, was 25. When studies prescribing very high doses of H2‐receptor antagonists (two of the outliers) were excluded, the odds ratio (for proton pump inhibitors vs. H2‐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 H2‐receptor antagonists when prescribed at usual doses with antibiotics to eradicate H. pylori infection.