{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T02:48:41Z","timestamp":1791514121765,"version":"4.3.4"},"reference-count":35,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,9,25]],"date-time":"2022-09-25T00:00:00Z","timestamp":1664064000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100014103","name":"Key Technology Research and Development Program of Shandong","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014103","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Helicobacter"],"published-print":{"date-parts":[[2022,12]]},"abstract":"Abstract<\/jats:title>\n \n Background & Aims<\/jats:title>\n \n Antibiotic resistance of\n Helicobacter pylori<\/jats:italic>\n (\n H.\u00a0pylori<\/jats:italic>\n ) is increasing worldwide, and bismuth quadruple therapy has been recommended as a first\u2010line regimen in many areas. This study aimed to investigate whether bismuth would improve the eradication rate (ER) of clarithromycin\u2010\/metronidazole\u2010\/levofloxacin\u2010resistant\n H.\u00a0pylori<\/jats:italic>\n strains and how much additional efficacy bismuth could achieve.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n PubMed, EMBASE, Web of Science, and Cochrane Central databases for randomized controlled trials were systematically searched by two independent reviewers until 15 January 2022. Pooled ERs of clarithromycin\u2010\/metronidazole\u2010\/levofloxacin\u2010resistant\n H.\u00a0pylori<\/jats:italic>\n strains were compared between bismuth\u2010containing and non\u2010bismuth therapies. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random\u2010effects model.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Eight studies enrolling 340 individuals were included. The RRs of pooled ERs compared between bismuth\u2010containing and non\u2010bismuth therapies were 1.83 for clarithromycin\u2010resistant strains (95% CI 1.16\u20132.89, pooled ER: 76.9% vs. 36.6%,\n p<\/jats:italic>\n \u00a0=\u00a0.009, I\n 2<\/jats:sup>\n \u00a0=\u00a00%), 1.39 for metronidazole\u2010resistant strains (95% CI 1.09\u20131.78, pooled ER: 86.8% vs. 60.9%,\n p<\/jats:italic>\n \u00a0=\u00a0.008, I\n 2<\/jats:sup>\n \u00a0=\u00a037%), 2.75 for dual clarithromycin\/metronidazole\u2010resistant strains (95% CI 1.01\u20137.52, pooled ER: 76.9% vs. 18.2%,\n p<\/jats:italic>\n \u00a0=\u00a0.05, I\n 2<\/jats:sup>\n \u00a0=\u00a00%), and 1.04 for levofloxacin\u2010resistant strains (95% CI 0.56\u20131.93, pooled ER: 63.4% vs. 54.3%,\n p<\/jats:italic>\n \u00a0=\u00a0.90; I\n 2<\/jats:sup>\n \u00a0=\u00a060%). Bismuth significantly increased the ERs of clarithromycin\u2010, metronidazole\u2010, and dual\u2010resistant strains by 40%, 26%, and 59%, respectively. Subgroup analysis of treatment duration showed that the significantly higher eradication rate for antibiotic\u2010resistant strains in bismuth\u2010containing therapy than non\u2010bismuth therapy was only observed in 14\u2010day treatment regimens and not in 7\u2010day regimens (\n p<\/jats:italic>\n \u00a0=\u00a0.02 and .17, respectively).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Bismuth was most effective in improving the ERs of dual\u2010resistant\n H.\u00a0pylori<\/jats:italic>\n strains, followed by clarithromycin\u2010 and metronidazole\u2010resistant strains. Prolonged treatment duration might effectively improve the efficacy of bismuth in overcoming antibiotic resistance.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/hel.12930","type":"journal-article","created":{"date-parts":[[2022,9,26]],"date-time":"2022-09-26T01:49:12Z","timestamp":1664156952000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Efficacy of bismuth for antibiotic\u2010resistant\n Helicobacter pylori<\/i>\n strains eradication: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"27","author":[{"given":"Zhongxue","family":"Han","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine Shandong University Jinan China"},{"name":"Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine Shandong University Jinan China"},{"name":"Robot engineering laboratory for precise diagnosis and therapy of GI tumor, Qilu Hospital, Cheeloo College of Medicine Shandong University Jinan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yueyue","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine Shandong University Jinan China"},{"name":"Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine Shandong University Jinan China"},{"name":"Robot engineering laboratory for precise diagnosis and therapy of GI tumor, Qilu Hospital, Cheeloo College of Medicine Shandong University Jinan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingzhou","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine Shandong University Jinan China"},{"name":"Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine Shandong University Jinan China"},{"name":"Robot engineering laboratory for precise diagnosis and therapy of GI tumor, Qilu Hospital, Cheeloo College of Medicine Shandong University Jinan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine Shandong University Jinan China"},{"name":"Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine Shandong University Jinan China"},{"name":"Robot engineering laboratory for precise diagnosis and therapy of GI tumor, Qilu Hospital, Cheeloo College of Medicine Shandong University Jinan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine Shandong University Jinan China"},{"name":"Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine Shandong University Jinan China"},{"name":"Robot engineering laboratory for precise diagnosis and therapy of GI tumor, Qilu Hospital, Cheeloo College of Medicine Shandong University Jinan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Wan","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine Shandong University Jinan China"},{"name":"Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine Shandong University Jinan China"},{"name":"Robot engineering laboratory for precise diagnosis and therapy of GI tumor, Qilu Hospital, Cheeloo College of Medicine Shandong University Jinan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minjuan","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine Shandong University Jinan China"},{"name":"Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine Shandong University Jinan China"},{"name":"Robot engineering laboratory for precise diagnosis and therapy of GI tumor, Qilu Hospital, Cheeloo College of Medicine Shandong University Jinan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boshen","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine Shandong University Jinan China"},{"name":"Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine Shandong University Jinan China"},{"name":"Robot engineering laboratory for precise diagnosis and therapy of GI tumor, Qilu Hospital, Cheeloo College of Medicine Shandong University Jinan 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