ObjectiveTo update evidence‐based data comparing the efficacy and safety of high‐dose dual therapy (HDDT) and bismuth‐containing quadruple therapy (BQT) in eradicating Helicobacter pylori infection through meta‐analysis.MethodsMultiple databases were systematically searched for randomized controlled trials (RCTs) published up to May 18, 2023. Dichotomous data were evaluated using risk ratio (RR) and 95% confidence interval (CI). Subgroup analysis, sensitivity analysis, risk of bias assessment, and quality of evidence evaluation were performed.ResultsTwenty RCTs containing 7891 subjects were included in the analysis. There was no statistically significant difference in H. pylori eradication rate between HDDT and BQT in the intention‐to‐treat (ITT) analysis (86.31% vs 84.88%; RR 1.02, 95% CI 1.00–1.04, P = 0.12). In the per‐protocol (PP) analysis, the eradication rates for HDDT and BQT were 90.27% and 89.94%, respectively (RR 1.01, 95% CI 0.99–1.03, P = 0.44). Adverse events were significantly lower with HDDT than with BQT (RR 0.44, 95% CI 0.38–0.51, P < 0.00001). Patient adherence was significantly different between the two groups (RR 1.01, 95% CI 1.00–1.03, P = 0.02). Subgroup analysis based on antibiotic combinations within the BQT group showed a significantly higher eradication rate for HDDT than for BQT only when BQT used amoxicillin combined with clarithromycin (P = 0.0009).ConclusionsHDDT showed comparable efficacy with BQT for H. pylori eradication, with fewer adverse effects and higher compliance. Due to regional differences, antibiotic resistance rates, and combined BQT antibiotics, more studies are needed for further validation and optimization of HDDT.

中文翻译：

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高剂量双重疗法与含铋四联疗法根除幽门螺杆菌：系统评价和荟萃分析

目的更新比较高剂量双重疗法（HDDT）和含铋四联疗法（BQT）根除结核病的有效性和安全性的循证数据幽门螺杆菌方法系统地搜索多个数据库以查找截至 2023 年 5 月 18 日发表的随机对照试验 (RCT)。使用风险比 (RR) 和 95% 置信区间 (CI) 评估二分数据。进行亚组分析、敏感性分析、偏倚风险评估和证据质量评估。结果纳入20个随机对照试验，共7891名受试者。没有统计学上显着的差异幽门螺杆菌意向治疗 (ITT) 分析中 HDDT 和 BQT 的根除率（86.31% vs 84.88%；RR 1.02，95% CI 1.00–1.04，磷= 0.12）。在符合方案 (PP) 分析中，HDDT 和 BQT 的根除率分别为 90.27% 和 89.94%（RR 1.01，95% CI 0.99–1.03，磷= 0.44）。 HDDT 的不良事件显着低于 BQT（RR 0.44，95% CI 0.38–0.51，磷< 0.00001)。两组患者的依从性存在显着差异（RR 1.01，95% CI 1.00–1.03，磷= 0.02）。基于 BQT 组内抗生素组合的亚组分析显示，仅当 BQT 使用阿莫西林联合克拉霉素时，HDDT 根除率显着高于 BQT（磷= 0.0009）。结论HDDT 在治疗方面表现出与 BQT 相当的功效幽门螺杆菌根除，不良反应更少，依从性更高。由于地区差异、抗生素耐药率以及联合使用 BQT 抗生素，需要更多的研究来进一步验证和优化 HDDT。