Helicobacter pylori as a cause of gastric cancer: the best treatment for eradication in iran (a systematic review)

Helicobacter pylori (H.pylori) is a bacterium that contaminates over 80 percent of the developing countries population such as Iran. Researchers indicate that H.pylori has a major role in gastric adenocarcinoma and mucosa-associated lymphoid tissue lymphoma (MALT). Therefore diagnosis and eradication of H.pylori is needed for all patients with gastric ulcers and upper gastrointestinal bleeding.Guidelines suggest triple regimen (including metronidazole, clarithromycin or amoxicillin and PPI) or quadruple regimen (bismuth-based), but some studies in Iran show that success of triple regimen hasdecreased to <70% and resistance to some of the quadruple regimen antibiotics has increased largely. Thus this article is going to suggest the best treatment for H.pylori eradication in Iran.PubMed,Cochrane, Scopus, Iran-medex and Magiran databases searched until October 2017 with H.pylori, tetracycline, amoxicillin, metronidazole, clarithromycin, Furazolidone, Bismuth, PPI and Iran keywords. All randomized clinical trials in English and Persian which surveyed treatment of H.pylori with these drugs were included and each paper was obtained, read and data extracted.21 articles entered our survey. In 11 articles success of H.pylori eradication was over 85% and only in 3 articles eradication was over 90%. In other 10 researches H.pylori eradication success was <85%. The highest percent of treatment was 94.3% in treatment with Furazolidone 100 mg b.i.d. for 14 days. The weighted mean cure rate for 14-days studies (eight studies) was 90% intention to treat. Resistance to Metronidazole was more than 15% and Clarithromycin showed an increase in resistance (11% to 13%).Due to metronidazole high resistance, high price of Clarithromycin in Iran and also the effectiveness of 14 – day treatment, it is suggested to use quadruple regimen 14-day therapy containing Furazolidone 100 mg b.i.d or t.i.d , Amoxicillin 1g b.i.d, Omeprazole 20mg and Bismuth 240mg b.i.d.

Keywords:

Gastric Cancer , Stomach Cancer , Cancer Prevention , Cancer Risks , Cancer Treatment and Management