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Susceptibility-Guided Versus Empirical First-Line Therapy of Helicobacter pylori Infection in Adults

2026-03-01Recensão Acesso aberto
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dc.contributor.authorRocha, Manuel Coelho
dc.contributor.authorGaspar, Tiago
dc.contributor.authorBernardes, Carlos
dc.contributor.authorNunes, Pedro Pimentel
dc.contributor.institutionNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
dc.contributor.pblWiley-Blackwell
dc.date.accessioned2026-04-22T09:02:01Z
dc.date.available2026-04-22T09:02:01Z
dc.date.issued2026-03-01
dc.descriptionPublisher Copyright: © 2026 The Author(s). Helicobacter published by John Wiley & Sons Ltd.
dc.description.abstractBackground: Antimicrobial resistance undermines empirical first-line regimens for Helicobacter pylori. We compared susceptibility-guided therapy (SGT) versus empirical therapy in adults receiving first-line treatment, focusing on intention-to-treat (ITT) eradication. Materials and Methods: We searched MEDLINE (PubMed), Web of Science, and Scopus from inception to 30 September 2025 for randomized controlled trials (RCTs) and non-randomized comparative studies (NRS) in adults with confirmed H. pylori. Interventions included phenotypic (culture/E-test) or genotypic (PCR) SGT applied to biopsy, stool, or gastric juice specimens; comparators were empirical regimens including bismuth quadruple therapy (BQT) and non-BQT options. The primary outcome was ITT eradication. We pooled risk ratios (RR) with DerSimonian–Laird random-effects, reported I2/τ2, and derived 95% prediction intervals (PI). Subgroups were prespecified by comparator family (BQT vs. other) and specimen/method. Multi-arm studies combined empirical arms within family or split across distinct families. Results: Forty-two studies met inclusion criteria; all contributed ITT data. RCTs (k = 33) favored SGT over empirical therapy (pooled RR 1.09, 95% CI 1.05–1.13; I2 73%; 95% PI 0.92–1.30). NRS (k = 12) were directionally consistent (pooled RR 1.15, 95% CI 1.10–1.22; I2 75%; 95% PI 0.99–1.35). In RCTs, effects were neutral-to-modest vs. BQT (RR 1.03, 95% CI 0.97–1.10) and clearer vs. other empirical regimens (RR 1.12, 95% CI 1.06–1.18). Conclusions: In adult first-line therapy, SGT achieves at least non-inferior—and often superior—eradication versus empirical regimens; the incremental benefit is attenuated where BQT is standard. These findings support selective, and increasingly justified, integration of susceptibility testing in settings with clinically relevant resistance.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent907397
dc.identifier.doi10.1111/hel.70125
dc.identifier.issn1083-4389
dc.identifier.otherPURE: 161024107
dc.identifier.otherPURE UUID: 95f94334-7f7b-45cf-9bd0-ec63b32bab9f
dc.identifier.otherScopus: 105035676518
dc.identifier.otherPubMed: 41981852
dc.identifier.urihttp://hdl.handle.net/10362/202448
dc.identifier.urlhttps://www.scopus.com/pages/publications/105035676518
dc.language.isoeng
dc.peerreviewedyes
dc.subjectantimicrobial resistance
dc.subjectbismuth quadruple therapy
dc.subjectculture
dc.subjectfirst-line
dc.subjectHelicobacter pylori
dc.subjectmeta-analysis
dc.subjectPCR
dc.subjectGastroenterology
dc.subjectInfectious Diseases
dc.subjectSDG 3 - Good Health and Well-being
dc.titleSusceptibility-Guided Versus Empirical First-Line Therapy of Helicobacter pylori Infection in Adultsen
dc.title.subtitleA Systematic Review and Meta-Analysisen
dc.typereview
degois.publication.issue2
degois.publication.titleHelicobacter
degois.publication.volume31
dspace.entity.typePublication
rcaap.rightsopenAccess

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