Abstract：
BACKGROUND: The eradication rate of Helicobacter pylori (H. pylori) remains variable for the same eradication regime even in the identical region, especially in developing countries. Herein, we conducted a systematic review to assess the effect of reinforced medication adherence on H. pylori eradication rate in developing countries.
METHODS: A systematic review was conducted in literature databases to identify relevant randomized controlled trials (RCTs) from inception to March 2023. The core indicator was the changes in eradication rate after enhanced adherence. A meta-analysis was performed to estimate the pooled relative risk (RR) or weighted mean difference (WMD) with 95% confidence intervals (CI).
RESULTS: Nineteen RCTs that included a total of 3286 patients were assessed. The measures to enhance compliance were mainly through face-to-face communication, phone calls, text messages, and social software. Compared with the control group, patients received reinforced measures showed a better medication adherence (89.6% vs. 71.4%, RR = 1.26 95% CI: 1.16-1.37), higher H. pylori eradication rate (intention-to-treat analysis: 80.2% vs. 65.9%, RR = 1.25, 95% CI: 1.12-1.31; per-protocol analysis: 86.8% vs. 74.8%, RR = 1.16, 95% CI: 1.09-1.23), higher symptom relief rates (81.8% vs. 65.1%, RR = 1.23, 95% CI: 1.09-1.38), higher degree of satisfaction (90.4% vs. 65.1%, RR = 1.26, 95% CI: 1.19-1.35), higher disease knowledge rates (SMD = 1.82, 95% CI: 0.77-2.86, p = 0.0007), and lower incidence of total adverse events (27.3% vs. 34.7%, RR = 0.72, 95% CI: 0.52-0.99).
CONCLUSIONS: Based on available evidence, reinforced medication adherence as a nonnegligible measure improves H. pylori eradication rate in developing countries.
METHODS: A systematic review was conducted in literature databases to identify relevant randomized controlled trials (RCTs) from inception to March 2023. The core indicator was the changes in eradication rate after enhanced adherence. A meta-analysis was performed to estimate the pooled relative risk (RR) or weighted mean difference (WMD) with 95% confidence intervals (CI).
RESULTS: Nineteen RCTs that included a total of 3286 patients were assessed. The measures to enhance compliance were mainly through face-to-face communication, phone calls, text messages, and social software. Compared with the control group, patients received reinforced measures showed a better medication adherence (89.6% vs. 71.4%, RR = 1.26 95% CI: 1.16-1.37), higher H. pylori eradication rate (intention-to-treat analysis: 80.2% vs. 65.9%, RR = 1.25, 95% CI: 1.12-1.31; per-protocol analysis: 86.8% vs. 74.8%, RR = 1.16, 95% CI: 1.09-1.23), higher symptom relief rates (81.8% vs. 65.1%, RR = 1.23, 95% CI: 1.09-1.38), higher degree of satisfaction (90.4% vs. 65.1%, RR = 1.26, 95% CI: 1.19-1.35), higher disease knowledge rates (SMD = 1.82, 95% CI: 0.77-2.86, p = 0.0007), and lower incidence of total adverse events (27.3% vs. 34.7%, RR = 0.72, 95% CI: 0.52-0.99).
CONCLUSIONS: Based on available evidence, reinforced medication adherence as a nonnegligible measure improves H. pylori eradication rate in developing countries.
摘要：
背景：幽门螺杆菌的根除率(H.幽门螺杆菌)即使在相同的区域，对于相同的根除方案也是可变的，尤其是在发展中国家。在这里，我们进行了系统评价,以评估在发展中国家加强用药依从性对幽门螺杆菌根除率的影响.
方法：在文献数据库中进行了系统评价，以确定从开始到2023年3月的相关随机对照试验（RCT）。核心指标是依从性增强后根除率的变化。进行荟萃分析，以95％置信区间（CI）估计合并相对风险（RR）或加权平均差（WMD）。
结果：评估了19项RCTs，共3286例患者。加强合规的措施主要是通过面对面沟通,电话,短信,社交软件。与对照组相比,接受强化措施的患者表现出更好的药物依从性(89.6%vs.71.4%,RR=1.2695%CI：1.16-1.37），幽门螺杆菌根除率较高(意向治疗分析：80.2%vs.65.9%,RR=1.25，95%CI：1.12-1.31；符合方案分析：86.8%vs.74.8%,RR=1.16，95%CI：1.09-1.23），更高的症状缓解率（81.8%vs.65.1%,RR=1.23，95%CI：1.09-1.38），满意度更高(90.4%与65.1%,RR=1.26，95%CI：1.19-1.35），更高的疾病知识率（SMD=1.82，95%CI：0.77-2.86，p=0.0007），总不良事件发生率较低(27.3%vs.34.7%,RR=0.72，95%CI：0.52-0.99）。
结论：根据现有证据，加强药物依从性作为一项不可忽视的措施,可提高发展中国家的幽门螺杆菌根除率.
方法：在文献数据库中进行了系统评价，以确定从开始到2023年3月的相关随机对照试验（RCT）。核心指标是依从性增强后根除率的变化。进行荟萃分析，以95％置信区间（CI）估计合并相对风险（RR）或加权平均差（WMD）。
结果：评估了19项RCTs，共3286例患者。加强合规的措施主要是通过面对面沟通,电话,短信,社交软件。与对照组相比,接受强化措施的患者表现出更好的药物依从性(89.6%vs.71.4%,RR=1.2695%CI：1.16-1.37），幽门螺杆菌根除率较高(意向治疗分析：80.2%vs.65.9%,RR=1.25，95%CI：1.12-1.31；符合方案分析：86.8%vs.74.8%,RR=1.16，95%CI：1.09-1.23），更高的症状缓解率（81.8%vs.65.1%,RR=1.23，95%CI：1.09-1.38），满意度更高(90.4%与65.1%,RR=1.26，95%CI：1.19-1.35），更高的疾病知识率（SMD=1.82，95%CI：0.77-2.86，p=0.0007），总不良事件发生率较低(27.3%vs.34.7%,RR=0.72，95%CI：0.52-0.99）。
结论：根据现有证据，加强药物依从性作为一项不可忽视的措施,可提高发展中国家的幽门螺杆菌根除率.
