Twenty-five studies were included (1547 patients), including twenty-one RCTs and four non-randomised studies.
Dual therapy (11 studies with 695 patients including 9 RCTs).
Mucosal defensive agents demonstrated significant additive effects in eradication rates. Pooled RR = 1.41 (95% CI: 1.24, 1.61). No significant heterogeneity was found (chi-squared P = 0.61).
Results were similar after exclusion of two non-randomised studies with R = 1.46 (95% CI: 1.27, 1.68). No significant heterogeneity was found (chi-squared P = 0.55).
Results were similar after excluding abstracts. RR = 1.48 (1.27, 1.73). No significant heterogeneity was found (chi-squared P = 0.59).
Triple therapy (7 studies with 852 patients, including 5 RCTs).
No significant effect was found after the addition of mucosal defensive agents.
Pooled RR = 1.06 (95% CI: 0.99, 1.15).
Results were similar after exclusion of two non-randomised studies with R = 1.06 (95% CI: 0.98, 1.15). Results were similar after excluding abstracts. RR = 1.08 (0.88, 1.31).
Individual agents.
Rebamide and ecabet sodium were significantly effective in ITT based eradication rates but studies for both agents were heterogeneous.
After exclusion of triple therapy studies, rebamipide and escabet sodium were significantly effective without heterogeneity.
Rebamipide (2 dual therapy RCTs with 193 patients): RR = 1.49 (95% CI: 1.17, 1.90).
Ecabet sodium (4 dual therapy RCTs with 305 patients): RR = 1.45 (95% CI: 1.17, 1.79).
Plaunotol (2 studies with 104 patients) was significantly effective in ITT based eradication rates with RR = 1.41 (95% CI: 1.13, 1.77).
Adverse effects (4 studies).
Agents failed to demonstrate a significant effect with RR = 1.04 (95% CI: 0.98, 1.09).