Summary

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• This summary is based on the review of 11 systematic review(s)/meta-analysis(es). ^[1-11]
• In H. pylori eradication, concomitant therapy (CT) was more effective than sequential therapy (ST), with CT achieving higher eradication rates, particularly in Asian populations and with proton pump inhibitors (PPIs) like lansoprazole, pantoprazole, and esomeprazole (relative risk (RR)=0.96, P<0.001 for per-protocol analysis; RR=0.94, P=0.005 for modified intent-to-treat analysis). Additionally, higher doses of esomeprazole and rabeprazole (40 mg twice daily) showed superior eradication rates, with rabeprazole reaching an 83.8% cure rate.
• H. pylori treatment effectiveness was influenced by CYP2C19 polymorphisms, with poor and intermediate metabolizers achieving higher cure rates using omeprazole and lansoprazole compared to extensive metabolizers, though such differences were not observed with esomeprazole, rabeprazole, or pantoprazole.
• For gastroesophageal reflux disease (GERD) and erosive esophagitis (EE), esomeprazole improved clinical symptoms and reduced relapse, ranking second in mucosal healing effectiveness for EE after ilaprazole and providing notable symptom relief in endoscopy-negative reflux disease. In Barrett's esophagus (BE), esomeprazole was beneficial for chemoprophylaxis when combined with acetylsalicylic acid.
• Concomitant therapy (CT) for H. pylori eradication was associated with a higher incidence of adverse events such as diarrhea, vomiting, dysgeusia, and dizziness compared to ST. Higher doses of esomeprazole (E40qd) also had an elevated adverse event rate (91.1%) compared to lower doses of esomeprazole and rabeprazole.
• In GERD and EE treatment, no significant differences in adverse event rates were observed among PPIs, vonoprazan, and placebo, indicating that esomeprazole and similar treatments were generally well-tolerated. However, esomeprazole was associated with fewer serious adverse events compared to placebo in GERD (RR = 1.406, P = 0.032).
• There is a potential cardiovascular risk linked to chronic esomeprazole use due to its inhibition of the enzyme dimethylarginine dimethylaminohydrolase 1 (DDAH1), which may increase the likelihood of cardiovascular events in long-term users, warranting monitoring for adverse cardiovascular outcomes.
• There are clinically relevant differences in H. pylori eradication and PPI effectiveness based on patient population characteristics: Asian populations responded better to CT compared to ST for H. pylori eradication, with improved outcomes in conjunction with PPIs like lansoprazole, pantoprazole, and esomeprazole. In addition, CYP2C19 polymorphisms affected eradication success, with higher cure rates in poor and intermediate metabolizers using omeprazole and lansoprazole, but not with esomeprazole, rabeprazole, or pantoprazole.