Evidence map›Paper›PMID 23751282›Full record

ArticleClinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association2014

Rational Helicobacter pylori therapy: evidence-based medicine rather than medicine-based evidence.

David Y Graham, Yi-Chia Lee, Ming-Shiang Wu

Registry-linked trialOpen access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05449028 (Helicobacter Pylori Eradication Therapy in Portugal), which is not on this map. Cited by 152 papers, 13 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
152citing papers in PubMed, 13 pooled it
31.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05449028 naunknown statusnot on this mapstarted 2022, after this paper: background citation

Helicobacter Pylori Eradication Therapy in Portugal: Prospective, Randomized, Blind and Multicentre Trial on the Efficacy of Quadruple Therapies and Their Clinical Impact, and Immunological and Gut Microbiota Changes

TypeinterventionalSponsorUnidade Local de Saúde de Coimbra, EPERan2022 to 2024Enrolled230ConditionsHelicobacter Pylori, Gut Microbiota, ImmunologyArmsH. pylori eradication scheme A, H. pylori eradication scheme B, H. pylori eradication scheme C, H. pylori eradication scheme D, H. pylori eradication scheme E
3 · Its place in the literature

Who cites it

152 citing papers in PubMed, 13 syntheses or guidelines pooled it, 338 citations in OpenAlex.

  1. [Evidence-Based Guidelines for the Diagnosis and Treatment ofThe Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi · 2026
    Guideline
  2. Minocycline in the eradication ofWorld journal of gastroenterology · 2024
    Pooled it
  3. Pooled it
  4. High-Dose Dual Therapy Versus Bismuth-Containing Quadruple Therapy for the Treatment of Helicobacter pylori Infection: A Systematic Review with Meta-Analysis.The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology · 2022
    Pooled it
  5. Guideline
  6. Guideline
  7. Fourth-generation quinolones in the treatment ofWorld journal of gastroenterology · 2018
    Pooled it
  8. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection.The American journal of gastroenterology · 2017
    Guideline
  9. Pooled it
  10. Pooled it
  11. Pooled it
  12. Pooled it
  13. Guideline
  14. Trial
  15. Trial
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92 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

3 authors at 2 institutions in 2 countries.

David Y GrahamDepartment of Medicine, Michael E. DeBakey VA Medical Center, and Baylor College of Medicine, Houston, Texas. Electronic address: dgraham@bcm.edu.
Yi-Chia LeeDepartment of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Ming-Shiang WuDepartment of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
National Taiwan University · TWBaylor College of Medicine · US

Funding

Tissue Analysis & Molecular Imaging CoreP30DK056338 · NIDDK · BAYLOR COLLEGE OF MEDICINE · PI James Versalovic · 2001 to 2026
$28.3M
Obesity, H pylori and Risk of Barrett's EsophagusR01CA116845 · NCI · BAYLOR COLLEGE OF MEDICINE · PI EL-SERAG, HASHEM B · 2007 to 2011
$2.8M
Gene Expression in Barrett's EsophagusR21DK067366 · NIDDK · BAYLOR COLLEGE OF MEDICINE · PI EL-SERAG, HASHEM B · 2005 to 2006
$296k
NCI NIH HHS R01 CA116845NIDDK NIH HHS P30 DK056338NIDDK NIH HHS R21 DK067366
6 · The paper itself

Abstract

Data are available such that choice of Helicobacter pylori therapy for an individual patient can be reliably predicted. Here, treatment success is defined as a cure rate of 90% or greater. Treatment outcome in a population or a patient can be calculated based on the effectiveness of a regimen for infections with susceptible and with resistant strains coupled with the knowledge of the prevalence of resistance (ie, based on formal measurement, clinical experience, or both). We provide the formula for predicting outcome and we illustrate the calculations. Because clarithromycin-containing triple therapy and 10-day sequential therapy are now only effective in special populations, they are considered obsolete; neither should continue to be used as empiric therapies (ie, 7- and 14-day triple therapies fail when clarithromycin resistance exceeds 5% and 15%, respectively, and 10-day sequential therapy fails when metronidazole resistance exceeds 20%). Therapy should be individualized based on prior history and whether the patient is in a high-risk group for resistance. The preferred choices for Western countries are 14-day concomitant therapy, 14-day bismuth quadruple therapy, and 14-day hybrid sequential-concomitant therapy. We also provide details regarding the successful use of fluoroquinolone-, rifabutin-, and furazolidone-containing therapies. Finally, we provide recommendations for the efficient development (ie, identification and optimization) of new regimens, as well as how to prevent or minimize failures. The trial-and-error approach for identifying and testing regimens frequently resulted in poor treatment success. The described approach allows outcome to be predicted and should simplify treatment and drug development.

Indexed as

Helicobacter pyloriAmoxicillinAnti-Bacterial AgentsBismuthClarithromycinDrug Resistance, BacterialDrug Therapy, CombinationEvidence-Based MedicineHelicobacter InfectionsHumansMetronidazoleTreatment FailureAmoxicillinAnti-Bacterial AgentsBismuthClarithromycinMetronidazoleAmoxicillinBismuthClarithromycinConcomitant TherapyEvidence BasedHelicobacter pyloriintention to treatITTMetronidazoleMITTmodified intention to treatper protocolPPPPIproton pump inhibitorProton Pump InhibitorsQuadruple TherapyReviewSequential TherapyTetracyclineTreatmentTreatment Success

Identifiers

PMID23751282
PMCPMC3830667
OpenAlexW1982900653

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.