Navegando por Palavras-chave "Helicobacter Pylori"

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    N-acetilcisteína como terapia adjuvante para erradicação de Helicobacter pylori. Revisão sistemática Cochrane
    (Universidade Federal de São Paulo (UNIFESP), 2019-04-25) Fontes, Luis Eduardo Santos [UNIFESP]; Riera, Rachel [UNIFESP]; http://lattes.cnpq.br/0591884301805680; http://lattes.cnpq.br/7387849617501693; Universidade Federal de São Paulo (UNIFESP)
    Purpose: To assess the efficacy and safety of N-acetylcysteine as an adjuvant therapy to antibiotics for Helicobacter pylori eradication. Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to present), Embase (1988 to present), CINAHL (1982 to present), and LILACS (1982 to present). The last search date was April 2018. We handsearched the reference lists of relevant studies. We screened 726 articles. Of these articles, we assessed 22 for eligibility. We included randomised controlled trials (RCTs) comparing NAC plus any antibiotic regimen with a control consisting of the same antibiotic regimen with or without placebo, in adult people infected with H pylori. Outcomes of interest were eradication rates, gastrointestinal, toxic, and allergic adverse events. Reporting of the primary outcomes listed here was not an inclusion criterion for the review. Two review authors independently reviewed and extracted data and completed the risk of bias assessment. A third review author independently confirmed the risk of bias assessment. We used Review Manager 5 software for data analysis. We contacted study authors if there was missing information. Results: The review included eight RCTs (n = 559). Studies have recruited outpatient adults between 17 and 76 years who were referred to endoscopy centres in several different countries. The certainty of evidence was reduced for most outcomes due to the poor methodological quality of included studies (mainly related to the generation of allocation sequence, allocation concealment, and blinding - this last one domain specifically for adverse outcomes). The small sample size of each single study that contributed for comparisons can be associated with an increased risk of type 2 error. We are uncertain whether the addition of NAC to antibiotics improves H pylori eradication rates, compared with the addition of placebo or no NAC (38.8% versus 49.1%, risk ratio (RR) 0.74, 95% confidence interval (CI) 0.51 to 1.08; participants = 559; studies = eight; very low-certainty evidence). A post-hoc sensitivity analysis, in which we removed studies that tested antibiotic regimens no longer recommended in clinical practice, showed that the addition of NAC may improve eradication rates compared to control (27.2% versus 37.6%, RR 0.71, 95% CI 0.53 to 0.94; participants = 397; published studies = five). We are uncertain whether NAC is associated with a higher risk of gastrointestinal adverse events compared to control (23.9% versus 18.9%, RR 1.25, 95% CI 0.85 to 1.85; participants = 336; studies = five; very low-certainty evidence), or allergic adverse events (2% versus 0%, RR 2.98, 95% CI 0.32 to 27.74; participants = 336; studies = five; very low-certainty evidence). There were no reports of toxic adverse events amongst included studies.Conclusion: We are uncertain whether the addition of NAC to antibiotics improves H pylori eradication rates compared with the addition of placebo or no NAC. Due to the clinical, statistical and methodological heterogeneity found in included studies, and the uncertainty observed when analyzing therapy subgroups, any possible beneficial effect of NAC should be regarded cautiously. We are uncertain whether NAC is associated with a higher risk of gastrointestinal or allergic adverse events compared with placebo or no NAC. There were no reports of toxic adverse events amongst the included studies. Further large, well-designed, randomised clinical studies should be conducted, with good reporting standards and appropriate collection of efficacy and safety outcomes, especially for current recommended antibiotic regimens.