Eleven RCTs (n=2,159) were included.
All 11 studies used ITT analysis, five were double-blind and three described withdrawals or drop-outs. Seven studies scored 3 or more out of 5 for validity.
There was a significant increase in the odds of H. pylori eradication with other PPIs compared with esomeprazole (OR 1.38, 95% CI: 1.09, 1.75, p=0.007); no statistically significant heterogeneity was detected (p=0.34; I-squared 10.6%). The results were similar and homogeneous when only studies that compared esomeprazole with omeprazole were included (OR 1.29, 95% CI: 1.01, 1.65).
The subgroup analysis of high-quality studies (6 RCTs, n=1,596) showed no statistically significant difference in eradication rates between esomeprazole-based and other PPI-based regimens (OR 1.17, 95% CI: 0.89, 1.54, p=0.25). No statistically significant heterogeneity was detected (p=0.87; I-squared 0%).
The subgroup analysis of low-dose (20 mg twice daily) esomeprazole (9 RCTs, n=1,666) and high-dose (40 mg twice daily) esomeprazole (2 RCTs) showed no significant differences in H. pylori eradication rates between esomeprazole-based and other PPI-based regimens (OR 1.20, 95% CI: 0.92, 1.56, p=0.17 and OR 3.21, 95% CI: 0.31, 32.93, respectively).
The asymmetrical funnel plot suggested the absence of some small negative studies.