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Treatment of Helicobacter pylori in the Arab world: a systematic review and network meta-analysis
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  • Shimaa Afify,
  • Muhammad Abdel-Gawad,
  • Eshak Bahbah,
  • Mariam Zaghloul,
  • Ahmed Abu-Elfatth,
  • Ahmed Alzamzamy,
  • Gina Naguib,
  • Doaa Elwazzan,
  • Nermeen Abdeen,
  • Mina Tharwat,
  • Osama Elbahr,
  • Iliass Charif,
  • Galal Aboufarrag ,
  • Mohamed El badry,
  • Dalia Omran,
  • Sherief Abd-Elsalam,
  • Zainab Ali-Eldin,
  • Nahed Makhlouf,
  • Mohamed Alboraie
Shimaa Afify
National Hepatology and Tropical Medicine Research Institute

Corresponding Author:[email protected]

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Muhammad Abdel-Gawad
Al-Azhar University - Assiut Branch
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Eshak Bahbah
Al-Azhar University
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Mariam Zaghloul
Kafrelsheikh University
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Ahmed Abu-Elfatth
Assiut University
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Ahmed Alzamzamy
Maadi Armed Forces Hospital
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Gina Naguib
Ain Shams University
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Doaa Elwazzan
Alexandria University
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Nermeen Abdeen
Alexandria University
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Mina Tharwat
Aswan University
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Osama Elbahr
Menoufia University National Liver Institute
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Iliass Charif
Al Farabi Hospital, Oujda
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Galal Aboufarrag
Al-Azhar University
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Mohamed El badry
Helwan University
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Dalia Omran
Cairo University
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Sherief Abd-Elsalam
Tanta University
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Zainab Ali-Eldin
Ain Shams University
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Nahed Makhlouf
Assiut University
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Mohamed Alboraie
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Abstract

Purpose: We aimed to conduct an updated systematic review and network meta-analysis (NMA) to estimate the efficacy of Helicobacter pylori (H. pylori) treatment strategies in Arab countries. Methods: We systematically searched PubMed, Scopus, Web of Science (WOS), EBSCO, and EMBASE from inception to July 18, 2020, using boolean operators. Retrieved articles were screened, and relevant data were extracted. We used R programming software to analyze extracted data. Results: Fifty-four articles (n= 7829 patients) were included in the NMA. Pooled overall analysis demonstrated that adjuvant therapy (standard triple or sequential therapy plus another adjuvant drug) was the best treatment with higher odds of eradication rate [OR= 6.42, 95% CI (1.37: 30.05), P-score= 0.21]. Moreover, Seqential therapy (SQT) and Quinolone based therapy (QBT) were associated with higher eradication rate compared to other regimens [OR= 4.83, 95% CI (1.49: 15.64), P-score= 0.30] and [OR= 4.32, 95% CI (1.15: 16.16), P-score= 0.36], respectively. In adults, the efficacy of QBT was higher than other stratigies in terms of H. pylori eradication [OR= 2.00, 95% CI (1.09, 3.69), P score= 0.19]. In naïve population, QBT and SQT were associated with substantial eradication rate [OR= 1.94, 95% CI (1.19: 3.16), P score=0.19] and [OR= 1.66, 95% CI (1.10: 2.50), P score=0.33], respectively. Conclusion: Our findings suggest that standard triple or sequential therapy plus another adjuvant drug, QBT and SQT therapies were the most effective regimens for eradicating H.pylori in Arab countries.