Eradication therapy for Helicobacter pylori in patients with gastric MALT-Lymphoma: a Pooled-data Analysis

OBJECTIVES: H. pylori eradication is recognized as the initial therapy for gastric low-grade, B-cell, MALT (mucosa-associated lymphoid tissue) lymphoma. This study assess: a) the H. pylori eradication rate following different first-, second-line and rescue therapies, and b) the reinfection rate in these patients. METHODS: Pooled-data analysis of systematic review of the literature. RESULTS: Data of 34 studies with 1,271 treated patients were considered. After first-line therapy, the infection was cured in 91% (95% CI = 89.492.5) of cases, eradication rate being higher following dual therapy as compared to the 7-day or 14-day triple therapies (p=0.0525). After second-line therapy, the eradication rate was 80.8% (95% CI = 82.795.1), being higher following triple than quadruple therapy. Further therapies (from three until to five attempts) cured the infection in 75% of patients. H. pylori infection was ultimately cured in 1,250 patients, accounting for an eradication rate of 98.3% (95% CI = 97.699) and 99.8% (95% CI = 99.6100) at intention-to-treat and per protocol analysis, respectively. Overall, bacterial reinfection occurred in 18 (2.7%; 95% CI = 1.43.9) out of 676 followed patients (0.7% yearly). CONCLUSIONS: This was the first, comprehensive (~1,300 patients) analysis on therapeutic management of H. pylori in gastric lymphoma patients. Data found that this infection seems to be easily managed in these patients, being cured in near all cases.