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Cochrane Database of Systematic Reviews

Periodontal therapy as adjunctive treatment for gastric Helicobacter pylori infection

Information

DOI:
https://doi.org/10.1002/14651858.CD009477.pub2Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 07 February 2016see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:

  1. Cochrane Gut Group

Copyright:
  1. Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Qian Ren

    Department of Gastroenterology, First Hospital of Lanzhou University, Lanzhou City, China

  • Xiang Yan

    Correspondence to: First Hospital of Lanzhou University, Lanzhou City, China

    [email protected]

    [email protected]

  • YongNing Zhou

    Department of Gastroenterology, First Hospital of Lanzhou University, Lanzhou City, China

  • Wei Xin Li

    Division of Geriatrics, First Hospital of Lanzhou University, Lanzhou City, China

Contributions of authors

Qian Ren drafted the review protocol and modified it according to the opinions of the editors and peer reviewers. Qian Ren undertook the literature search, extracted and analyzed data, and wrote the review. WeiXin Li performed the literature search, original data extraction, and analysis. Xiang Yan and YongNing Zhou participated in analysing data and interpreting the results. All authors contributed to the completed systematic review.

Sources of support

Internal sources

  • The First Hospital of Lanzhou University, China.

External sources

  • The Evidence‐Based Medicine Center of Lanzhou University, China.

Declarations of interest

QR: none known.

XY: none known.

YNZ: none known.

WXL: none known.

Acknowledgements

We thank Professor KeHu Yang and Bin Ma for their guidance and help. We thank the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group (UGPD) for their support.

Version history

Published

Title

Stage

Authors

Version

2016 Feb 07

Periodontal therapy as adjunctive treatment for gastric <i>Helicobacter pylori</i> infection

Review

Qian Ren, Xiang Yan, YongNing Zhou, Wei Xin Li

https://doi.org/10.1002/14651858.CD009477.pub2

2011 Dec 07

Periodontal therapy as adjunctive treatment for gastric Helicobacter pylori infection

Protocol

Qian Ren, Xiang Yan, YongNing Zhou, Wei Xin Li

https://doi.org/10.1002/14651858.CD009477

Differences between protocol and review

In the protocol stage, we planned to include randomized controlled trials comparing periodontal therapy plus triple therapy with triple therapy alone. However, in the review, we actually included patients treated with eradication therapy comprising triple therapy, quadruple therapy, sequential therapy and concomitant therapy, only excluding dual therapy because of the low eradication rate. According to the comments of statistical editor and considering the balance of randomisation, we used 'non‐recurrence rate' instead of 'recurrence rate' to evaluate periodontal therapy for gastric H. pylori at long‐term follow up. Additionally, we searched both ClinicalTrials.gov and the WHO ICTRP portal to reduce potential bias as much as possible.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Adolescent; Adult; Aged; Humans; Middle Aged;

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Search flow diagram
Figures and Tables -
Figure 1

Search flow diagram

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 Eradication therapy combined with periodontal therapy versus eradication therapy alone, Outcome 1 Eradication rate of gastricH.pylori.
Figures and Tables -
Analysis 1.1

Comparison 1 Eradication therapy combined with periodontal therapy versus eradication therapy alone, Outcome 1 Eradication rate of gastricH.pylori.

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Comparison 1 Eradication therapy combined with periodontal therapy versus eradication therapy alone, Outcome 2 Non‐recurrence rate of gastric H.pylori.
Figures and Tables -
Analysis 1.2

Comparison 1 Eradication therapy combined with periodontal therapy versus eradication therapy alone, Outcome 2 Non‐recurrence rate of gastric H.pylori.

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Comparison 2 Subgroup analysis: Stratified by different oral H.pylori status, Outcome 1 Eradication rate of gastricH.pylori.
Figures and Tables -
Analysis 2.1

Comparison 2 Subgroup analysis: Stratified by different oral H.pylori status, Outcome 1 Eradication rate of gastricH.pylori.

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Comparison 3 Subgroup analysis: Stratified by different durations of periodontal therapy, Outcome 1 Eradication rate of gastricH.pylori.
Figures and Tables -
Analysis 3.1

Comparison 3 Subgroup analysis: Stratified by different durations of periodontal therapy, Outcome 1 Eradication rate of gastricH.pylori.

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Comparison 3 Subgroup analysis: Stratified by different durations of periodontal therapy, Outcome 2 Non‐recurrence rate of gastricH.pylori.
Figures and Tables -
Analysis 3.2

Comparison 3 Subgroup analysis: Stratified by different durations of periodontal therapy, Outcome 2 Non‐recurrence rate of gastricH.pylori.

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Comparison 4 Subgroup analysis: After removing low‐quality studies, Outcome 1 Eradication rate of gastric H.pylori.
Figures and Tables -
Analysis 4.1

Comparison 4 Subgroup analysis: After removing low‐quality studies, Outcome 1 Eradication rate of gastric H.pylori.

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Summary of findings for the main comparison. Eradication therapy combined with periodontal therapy versus eradication therapy alone for gastric Helicobacter pylori infection

Eradication therapy combined with periodontal therapy versus eradication therapy alone for gastric Helicobacter pylori infection

Patient or population: patients with gastric Helicobacter pylori infection
Settings: outpatient clinic
Intervention: eradication therapy combined with periodontal therapy versus eradication therapy alone

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

Eradication therapy alone

Eradication therapy combined with periodontal therapy

Eradication rate of gastric H. pylori

60 per 100

76 per 100
(69 to 82)

OR 2.15
(1.47 to 3.14)

543
(6 studies)

⊕⊕⊕⊝
moderatea

Non‐recurrence rate of gastric H. pylori

29 per 100

60 per 100
(47 to 72)

OR 3.60
(2.11 to 6.15)

299
(3 studies)

⊕⊕⊝⊝
lowb,c,d

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; OR: Odds ratio.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

aDowngraded one level due to risk of bias (only Zaric 2009 described methods of randomization).
bDowngraded one level due to risk of bias (all patients in Jia 2009a were successfully treated for gastric H. pylori after triple eradication therapy).
cAlthough OR value was 3.60, we decided not to upgrade the quality of evidence because all patients in Jia 2009a were successfully treated for gastric H. pylori after triple eradication therapy.
dDowngraded one level due to imprecision (less than 400 total participants).

Figures and Tables -
Summary of findings for the main comparison. Eradication therapy combined with periodontal therapy versus eradication therapy alone for gastric Helicobacter pylori infection
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Comparison 1. Eradication therapy combined with periodontal therapy versus eradication therapy alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Eradication rate of gastricH.pylori Show forest plot

6

543

Odds Ratio (M‐H, Fixed, 95% CI)

2.15 [1.47, 3.14]

2 Non‐recurrence rate of gastric H.pylori Show forest plot

3

299

Odds Ratio (M‐H, Fixed, 95% CI)

3.60 [2.11, 6.15]
Figures and Tables -
Comparison 1. Eradication therapy combined with periodontal therapy versus eradication therapy alone
Navigate to table in Review
Comparison 2. Subgroup analysis: Stratified by different oral H.pylori status

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Eradication rate of gastricH.pylori Show forest plot

6

543

Odds Ratio (M‐H, Fixed, 95% CI)

2.15 [1.47, 3.14]

1.1 Patients with defined oral H.pylori

3

327

Odds Ratio (M‐H, Fixed, 95% CI)

2.42 [1.52, 3.87]

1.2 Patients who were not tested for oral H.pylori

3

216

Odds Ratio (M‐H, Fixed, 95% CI)

1.70 [0.88, 3.26]
Figures and Tables -
Comparison 2. Subgroup analysis: Stratified by different oral H.pylori status
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Comparison 3. Subgroup analysis: Stratified by different durations of periodontal therapy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Eradication rate of gastricH.pylori Show forest plot

6

543

Odds Ratio (M‐H, Fixed, 95% CI)

2.15 [1.47, 3.14]

1.1 Periodontal therapy during eradication therapy

2

108

Odds Ratio (M‐H, Fixed, 95% CI)

2.72 [1.20, 6.14]

1.2 Periodontal therapy continued until testing the result of eradication therapy

4

435

Odds Ratio (M‐H, Fixed, 95% CI)

2.02 [1.31, 3.10]

1.3 Periodontal therapy continued for longer

0

0

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Non‐recurrence rate of gastricH.pylori Show forest plot

3

299

Odds Ratio (M‐H, Fixed, 95% CI)

3.60 [2.11, 6.15]

2.1 Periodontal therapy during eradication therapy

0

0

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.2 Periodontal therapy continued until testing the result of eradication therapy

2

151

Odds Ratio (M‐H, Fixed, 95% CI)

3.13 [1.60, 6.10]

2.3 Periodontal therapy continued for longer

1

148

Odds Ratio (M‐H, Fixed, 95% CI)

4.49 [1.83, 11.04]
Figures and Tables -
Comparison 3. Subgroup analysis: Stratified by different durations of periodontal therapy
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Comparison 4. Subgroup analysis: After removing low‐quality studies

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Eradication rate of gastric H.pylori Show forest plot

2

175

Odds Ratio (M‐H, Fixed, 95% CI)

3.18 [1.60, 6.33]
Figures and Tables -
Comparison 4. Subgroup analysis: After removing low‐quality studies
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