黄连素、大黄素、五味子及黄芩苷对幽门螺杆菌多重耐药株的体外抑菌作用

Efficacy and safety of triple therapy containing berberine, amoxicillin, and vonoprazan for Helicobacter pylori initial treatment: A randomized controlled trial

BACKGROUND

With the development of traditional Chinese medicine research, berberine has shown good efficacy and safety in the eradication of Helicobacter pylori (H. pylori). The present study aimed to evaluate the efficacy and safety of triple therapy containing berberine, amoxicillin, and vonoprazan for the initial treatment of H. pylori.

METHODS

This study was a single-center, open-label, parallel, randomized controlled clinical trial. Patients with H. pylori infection were randomly (1:1:1) assigned to receive berberine triple therapy (berberine 500 mg, amoxicillin 1000 mg, vonoprazan 20 mg, A group), vonoprazan quadruple therapy (vonoprazan 20 mg, amoxicillin 1000 mg, clarithromycin 500 mg, colloidal bismuth tartrate 220 mg, B group), or rabeprazole quadruple therapy (rabeprazole 10 mg, amoxicillin 1000 mg, clarithromycin 500 mg, colloidal bismuth tartrate 220 mg, C group). The drugs were taken twice daily for 14 days. The main outcome was the H. pylori eradication rate. The secondary outcomes were symptom improvement rate, patient compliance, and incidence of adverse events. Furthermore, factors affecting the eradication rate of H. pylori were further analyzed.

RESULTS

A total of 300 H. pylori-infected patients were included in this study, and 263 patients completed the study. An intention-to-treat (ITT) analysis showed that the eradication rates of H. pylori in berberine triple therapy, vonoprazan quadruple therapy, and rabeprazole quadruple therapy were 70.0% (70/100), 77.0% (77/100), and 69.0% (69/100), respectively. The per-protocol (PP) analysis showed that the eradication rates of H. pylori in these three groups were 81.4% (70/86), 86.5% (77/89), and 78.4% (69/88), respectively. Both ITT analysis and PP analysis showed that the H. pylori eradication rate did not significantly differ among the three groups (P >0.05). In addition, the symptom improvement rate, overall adverse reaction rate, and patient compliance were similar among the three groups (P >0.05).

CONCLUSIONS

The efficacy of berberine triple therapy for H. pylori initial treatment was comparable to that of vonoprazan quadruple therapy and rabeprazole quadruple therapy, and it was well tolerated. It could be used as one choice of H. pylori initial treatment.

Efficacy of traditional Chinese medicine as adjunctive treatment for Helicobacter pylori: A meta-analysis

BACKGROUND

Helicobacter pylori (H. pylori) infection is a significant risk factor for gastrointestinal diseases, and the eradication of H. pylori is a critical measure for many diseases. In recent years, however, the resistance rate of H. pylori to antibiotics has increased and the eradication rate of H. pylori has decreased. There are many studies on the adjuvant treatment of H. pylori infection with traditional Chinese medicine (TCM), but the results on the efficacy are conflicting. It is still unclear whether TCM can improve the eradication rate of H. pylori.

AIM

To systematically evaluate the adjunctive role of TCM in H. pylori eradication.

METHODS

Databases, including CNKI, CBM, PubMed, EMBASE, and the Cochrane Library, were searched. Randomized controlled trials (RCTs) comparing the efficacy of TCM plus Western medicine (triple therapy, quadruple therapy, sequential therapy and so on) and Western medicine alone for H. pylori eradication were retrieved. The time was limited to January 1983 to November 2019. Revman 5.3 and Stata 16 statistical software were used for analysis.

RESULTS

Twenty-four articles on RCTs were collected, and their risk of quality deviation and the published offset may be lower. We performed a meta-analysis of these 24 articles, and there was significant heterogeneity between the studies (P < 0.01, I² = 59%). After excluding the studies with significantly different research methods, there was still significant heterogeneity (P < 0.1, I² > 50%). The meta-analysis was done with the random-effects model, which revealed that the efficacy of TCM plus Western medicine was significantly better than that of Western medicine alone [odds ratio (OR) = 1.66, 95% confidence interval (CI): 1.28-2.15, P < 0.05]. The eradication rate of H. pylori in the combination group was significantly better than that in the Western medicine alone group (OR = 1.94, 95%CI: 1.36-2.75, P < 0.05; OR = 1.93, 95%CI: 1.47-2.54, P < 0.05). The eradication rates of H. pylori in the 7-d subgroup (OR = 2.07, 95%CI: 1.01-4.22, P = 0.05), 14-d subgroup (OR = 1.94, 95%CI: 1.54-2.45, P < 0.05), syndrome differentiation-based treatment subgroup (OR = 2.19, 95%CI: 1.53-3.14, P < 0.05), peptic ulcer subgroup (OR = 2.03, 95%CI: 1.14-3.59, P < 0.05), mixed disease subgroup (OR = 1.49, 95%CI: 1.17-1.89, P < 0.05), eradication times-nonspecified subgroup (OR = 2.09, 95%CI: 1.58-2.77, P < 0.05), decoction type subgroup (OR = 2.54, 95%CI: 1.88-3.43, P < 0.05) in the combination group were much better than that of the Western medicine alone group (P < 0.05). There was no significant difference (P > 0.05) between the other subgroups and the Western medicine alone group. Sensitivity analysis showed the similar results (OR > 1, P < 0.05).

CONCLUSION

TCM has certain benefits in the treatment of H. pylori infection. There may be more benefits if we select the patients according to the principle of syndrome differentiation, use the decoction, and apply only to patients with peptic ulcer.