S2097 Comparative Efficacy of Tailored and Concomitant Therapy as First-Line Treatment for H. pylori: A Systematic Review and Meta-Analysis

Introduction: Rising antibiotic resistance has prompted interest in susceptibility-guided tailored therapy as an alternative to standard empirical regimens for Helicobacter pylori eradication. While concomitant therapy is a widely used empirical approach, the comparative efficacy and safety of tailored therapy versus concomitant therapy as first-line treatment remain uncertain. We performed a meta‐analysis of randomized controlled trials (RCTs) comparing tailored versus concomitant therapy in patients with H. pylori infection. Methods: We conducted a comprehensive literature search of PubMed, ScienceDirect, Cochrane CENTRAL, clinicaltrials.gov, and Google Scholar through May 2025 to identify studies comparing tailored therapy versus concomitant therapy for H. pylori eradication. Studies were included if they enrolled patients with confirmed H. pylori infection and reported at least 1 of the following outcomes: intention-to-treat (ITT) eradication rate, per-protocol (PP) eradication rate, compliance, or adverse events. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed using the I² statistic, and all analyses were performed using Review Manager 5.4. Results: Eight RCTs (n = 2,534; 1,374 assigned to tailored therapy and 1,208 assigned to concomitant therapy) met the eligibility criteria. The eradication rates were significantly higher in the tailored group than in the concomitant group in both the ITT analysis (87.4% vs 83.2%; RR 1.05; [95% CI: 1.00 to 1.10]; P = 0.05) and PP analysis (92.6% vs 89.1%, RR 1.04; [95% CI: 1.00 to 1.07]; P = 0.03). Adverse events occurred less frequently with tailored therapy than with concomitant therapy (35.6% vs 45.6%; RR 0.71; [95% CI 0.58 to 0.86]; P = 0.0007). Conclusion: We found that tailored therapy was associated with higher eradication rates and fewer adverse events compared to concomitant therapy. These findings suggest that tailored therapy provides a more effective option for H. pylori eradication, especially in settings with antibiotic resistance.