{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T15:26:08Z","timestamp":1776785168052,"version":"3.51.2"},"reference-count":61,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2022,10,4]],"date-time":"2022-10-04T00:00:00Z","timestamp":1664841600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Helicobacter pylori (H. pylori) is the most prevalent etiology of gastritis worldwide. H. pylori management depends mainly on antibiotics, especially the triple therapy formed of clarithromycin, amoxicillin, and proton pump inhibitors. Lately, many antibiotic-resistant strains have emerged, leading to a decrease in the eradication rates of H. pylori. Polaprezinc (PZN), a mucosal protective zinc-L-carnosine complex, may be a non-antibiotic agent to treat H. pylori without the risk of resistance. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of a PZN-based regimen for the eradication of H. pylori. This study used a systematic review and meta-analysis synthesizing randomized controlled trials (RCTs) from WOS, SCOPUS, EMBASE, PubMed, and Google Scholar until 25 July 2022. We used the odds ratio (OR) for dichotomous outcomes presented with the corresponding 95% confidence interval (CI). We registered our protocol in PROSPERO with ID: CRD42022349231. We included 3 trials with a total of 396 participants who were randomized to either PZN plus triple therapy (n = 199) or triple therapy alone (control) (n = 197). Pooled OR found a statistical difference favoring the PZN arm in the intention to treat and per protocol H. pylori eradication rates (OR: 2.01 with 95% CI [1.27, 3.21], p = 0.003) and (OR: 2.65 with 95% CI [1.55, 4.54], p = 0.0004), respectively. We found no statistical difference between the two groups regarding the total adverse events (OR: 1.06 with 95% CI [0.55, 2.06], p = 0.85). PZN, when added to the triple therapy, yielded a better effect concerning the eradication rates of H. pylori with no difference in adverse event rates, and thus can be considered a valuable adjuvant for the management of H. pylori. However, the evidence is still scarce, and larger trials are needed to confirm or refute our findings.<\/jats:p>","DOI":"10.3390\/nu14194126","type":"journal-article","created":{"date-parts":[[2022,10,10]],"date-time":"2022-10-10T01:21:07Z","timestamp":1665364867000},"page":"4126","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Efficacy and Safety of Polaprezinc-Based Therapy versus the Standard Triple Therapy for Helicobacter pylori Eradication: A Systematic Review and Meta-Analysis of Randomized Controlled Trials"],"prefix":"10.3390","volume":"14","author":[{"given":"Abdelrahman","family":"Mahmoud","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Minia University, Minia 61519, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Abuelazm","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Tanta University, Tanta 31527, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3870-5148","authenticated-orcid":false,"given":"Ali Ashraf Salah","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Minia University, Minia 61519, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hassan","family":"Abdalshafy","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Cairo University, Cairo 11562, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2919-6196","authenticated-orcid":false,"given":"Basel","family":"Abdelazeem","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, McLaren Health Care, Flint, MI 48532, USA"},{"name":"Department of Internal Medicine, Michigan State University, East Lansing, MI 48823, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3948-4853","authenticated-orcid":false,"given":"James Robert","family":"Bra\u0161i\u0107","sequence":"additional","affiliation":[{"name":"Section of High Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1053\/j.gastro.2017.04.022","article-title":"Global prevalence of Helicobacter pylori infection: Systematic review and meta-analysis","volume":"153","author":"Hooi","year":"2017","journal-title":"Gastroenterology"},{"key":"ref_2","unstructured":"Global Burden of Disease Cancer Collaboration, Fitzmaurice, C., Abate, D., Abbasi, N., Abbastabar, H., Abd-Allah, F., Abdel-Rahman, O., Abdelalim, A., Abdoli, A., and Abdollahpour, I. (2019). Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2017: A systematic analysis for the global burden of disease study. JAMA Oncol., 5, 1749\u20131768."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Wang, Z., Liu, Y., Peng, Y., and Peng, L. (2022). Helicobacter pylori Infection\u2014A risk factor for irritable bowel syndrome? An updated systematic review and meta-analysis. Medicina, 58.","DOI":"10.3390\/medicina58081035"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1159\/000365310","article-title":"An update on Helicobacter pylori as the cause of gastric cancer","volume":"1","author":"Zhang","year":"2014","journal-title":"Gastrointest. Tumors"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/S2468-1253(16)30023-1","article-title":"Pathophysiology of irritable bowel syndrome","volume":"1","author":"Holtmann","year":"2016","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"6759","DOI":"10.3748\/wjg.v20.i22.6759","article-title":"Irritable bowel syndrome: Pathogenesis, diagnosis, treatment, and evidence-based medicine","volume":"20","author":"Saha","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1046\/j.1523-5378.1998.08031.x","article-title":"H. pylori and cagA: Relationships with gastric cancer, duodenal ulcer, and reflux esophagitis and its complications","volume":"3","author":"Graham","year":"1998","journal-title":"Helicobacter"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1186\/s12929-018-0469-6","article-title":"H. pylori infection and extra-gastroduodenal diseases","volume":"25","author":"Tsay","year":"2018","journal-title":"J. Biomed. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e18348","DOI":"10.1097\/MD.0000000000018348","article-title":"Effect of Helicobacter pylori infection on the risk of acute coronary syndrome: A systematic review and meta-analysis","volume":"98","author":"Fang","year":"2019","journal-title":"Medicine"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Szwed, P., G\u0105secka, A., Zawadka, M., Eyileten, C., Postu\u0142a, M., Mazurek, T., Szarpak, \u0141., and Filipiak, K.J. (2021). Infections as novel risk factors of atherosclerotic cardiovascular diseases: Pathophysiological links and therapeutic implications. J. Clin. Med., 10.","DOI":"10.3390\/jcm10122539"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3238","DOI":"10.1007\/s00415-020-09933-x","article-title":"Association between Helicobacter pylori infection and stroke: A meta-analysis of 273, 135 patients","volume":"268","author":"Doheim","year":"2021","journal-title":"J. Neurol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1080\/00207454.2020.1738432","article-title":"Alzheimer\u2019s disease and gastrointestinal microbiota; impact of Helicobacter pylori infection involvement","volume":"131","author":"Doulberis","year":"2021","journal-title":"Int. J. Neurosci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1021\/acschemneuro.9b00607","article-title":"Association of intestinal disorders with Parkinson\u2019s disease and Alzheimer\u2019s disease: A systematic review and meta-analysis","volume":"11","author":"Fu","year":"2020","journal-title":"ACS Chem. Neurosci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"5578","DOI":"10.3748\/wjg.v25.i37.5578","article-title":"Pathogenesis and clinical management of Helicobacter pylori gastric infection","volume":"25","author":"Soares","year":"2019","journal-title":"World J. Gastroenterol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1724","DOI":"10.1136\/gutjnl-2022-327745","article-title":"Management of Helicobacter pylori infection-the Maastricht VI\/Florence consensus report","volume":"71","author":"Malfertheiner","year":"2022","journal-title":"Gut"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1053\/j.gastro.2021.04.012","article-title":"Comparative effectiveness of multiple different first-line treatment regimens for Helicobacter pylori infection: A network meta-analysis","volume":"161","author":"Rokkas","year":"2021","journal-title":"Gastroenterology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.2147\/IDR.S173867","article-title":"Antibiotic resistance: A rundown of a global crisis","volume":"11","author":"Aslam","year":"2018","journal-title":"Infect. Drug Resist."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Bujanda, L., Nyssen, O.P., Vaira, D., Saracino, I.M., Fiorini, G., Lerang, F., Georgopoulos, S., Tepes, B., Heluwaert, F., and Gasbarrini, A. (2021). Antibiotic resistance prevalence and trends in patients infected with Helicobacter pylori in the period 2013\u20132020: Results of the European Registry on H. pylori Management (Hp-EuReg). Antibiotics, 10.","DOI":"10.3390\/antibiotics10091058"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1053\/j.gastro.2018.07.007","article-title":"Prevalence of antibiotic resistance in Helicobacter pylori: A systematic review and meta-analysis in World Health Organization regions","volume":"155","author":"Savoldi","year":"2018","journal-title":"Gastroenterology"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Andreev, D.N., Maev, I.V., and Dicheva, D.T. (2019). Efficiency of the inclusion of rebamipide in the eradication therapy for Helicobacter pylori infection: Meta-analysis of randomized controlled studies. J. Clin. Med., 8.","DOI":"10.3390\/jcm8091498"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"S155","DOI":"10.1111\/j.1440-1746.2010.06232.x","article-title":"Sofalcone, a gastroprotective drug, promotes gastric ulcer healing following eradication therapy for Helicobacter pylori: A randomized controlled comparative trial with cimetidine, an H2-receptor antagonist","volume":"25","author":"Higuchi","year":"2010","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"4936318","DOI":"10.1155\/2020\/4936318","article-title":"Efficacy of sucralfate-combined quadruple therapy on gastric mucosal injury induced by Helicobacter pylori and its effect on gastrointestinal flora","volume":"2020","author":"Teng","year":"2020","journal-title":"BioMed Res. Int."},{"key":"ref_23","unstructured":"National Center for Biotechnology Information (2022, October 03). PubChem Compound Summary for CID 51051629, Polaprezinc, Available online: https:\/\/pubchem.ncbi.nlm.nih.gov\/compound\/51051629."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"227","DOI":"10.12998\/wjcc.v10.i1.227","article-title":"Zinc carnosine-based modified bismuth quadruple therapy vs standard triple therapy for Helicobacter pylori eradication: A randomized controlled study","volume":"10","author":"Ibrahim","year":"2022","journal-title":"World J. Clin. Cases"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1046\/j.1523-5378.2002.00114.x","article-title":"Polaprezinc attenuates Helicobacter pylori-associated gastritis in Mongolian gerbils","volume":"7","author":"Ishihara","year":"2002","journal-title":"Helicobacter"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1629","DOI":"10.3748\/wjg.v11.i11.1629","article-title":"Sofalcone, a mucoprotective agent, increases the cure rate of Helicobacter pylori infection when combined with rabeprazole, amoxicillin and clarithromycin","volume":"11","author":"Isomoto","year":"2005","journal-title":"World J. Gastroenterol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1046\/j.1365-2036.1999.00510.x","article-title":"Polaprezinc, a mucosal protective agent, in combination with lansoprazole, amoxycillin and clarithromycin increases the cure rate of Helicobacter pylori infection","volume":"13","author":"Kashimura","year":"1999","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Tan, B., Luo, H.-Q., Xu, H., Lv, N.-H., Shi, R.-H., Luo, H.-S., Li, J.-S., Ren, J.-L., Zou, Y.-Y., and Li, Y.-Q. (2017). Polaprezinc combined with clarithromycin-based triple therapy for Helicobacter pylori-associated gastritis: A prospective, multicenter, randomized clinical trial. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0175625"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Hewlings, S., and Kalman, C. (2020). A review of zinc-L-carnosine and its positive effects on oral mucositis, taste disorders, and gastrointestinal disorders. Nutirents, 12.","DOI":"10.3390\/nu12030665"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3782","DOI":"10.3390\/nu7053783","article-title":"Oral zinc supplementation reduces the erythropoietin responsiveness index in patients on hemodialysis","volume":"7","author":"Kobayashi","year":"2015","journal-title":"Nutrients"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Kawahara, M., Tanaka, K.-i., and Kato-Negishi, M. (2018). Zinc, carnosine, and neurodegenerative diseases. Nutrients, 10.","DOI":"10.3390\/nu10020147"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Furihata, K., Tsuchikawa, M., Miwa, T., Naito, Y., Oba, K., and Sakagami, M. (2020). Efficacy and safety of polaprezinc (zinc compound) on zinc deficiency: A systematic review and dose-response meta-analysis of randomized clinical trials using individual patient data. Nutrients, 12.","DOI":"10.3390\/nu12041128"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1155\/2002\/631070","article-title":"Inhibitory effect of polaprezinc on the inflammatory response to Helicobacter pylori","volume":"16","author":"Handa","year":"2002","journal-title":"Can. J. Gastroenterol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1269\/jrr.07114","article-title":"Protection by polaprezinc against radiation-induced apoptosis in rat jejunal crypt cells","volume":"49","author":"Shichijo","year":"2008","journal-title":"J. Radiat. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1007\/s00535-010-0213-9","article-title":"Reactive oxygen species-quenching and anti-apoptotic effect of polaprezinc on indomethacin-induced small intestinal epithelial cell injury","volume":"45","author":"Omatsu","year":"2010","journal-title":"J. Gastroenterol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1254\/jjp.84.63","article-title":"Protection by polaprezinc, an anti-ulcer drug, against indomethacin-induced apoptosis in rat gastric mucosal cells","volume":"84","author":"Fujii","year":"2000","journal-title":"Jpn. J. Pharmacol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1017\/S0007114509289033","article-title":"Supplemental zinc reduced intestinal permeability by enhancing occludin and zonula occludens protein-1 (ZO-1) expression in weaning piglets","volume":"102","author":"Zhang","year":"2009","journal-title":"Br. J. Nutr."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1664","DOI":"10.1093\/jn\/138.9.1664","article-title":"Zinc deficiency induces membrane barrier damage and increases neutrophil transmigration in Caco-2 cells","volume":"138","author":"Finamore","year":"2008","journal-title":"J. Nutr."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1136\/gut.2006.099929","article-title":"Zinc carnosine, a health food supplement that stabilises small bowel integrity and stimulates gut repair processes","volume":"56","author":"Mahmood","year":"2007","journal-title":"Gut"},{"key":"ref_40","first-page":"20","article-title":"Effect of polaprezinc on impaired healing of chronic gastric ulcers in adjuvant-induced arthritic rats: Role of insulin-like growth factors (IGF)-1","volume":"7","author":"Kato","year":"2001","journal-title":"Med. Sci. Monit."},{"key":"ref_41","first-page":"Ed000142","article-title":"Updated guidance for trusted systematic reviews: A new edition of the Cochrane Handbook for Systematic Reviews of Interventions","volume":"10","author":"Cumpston","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"n160","DOI":"10.1136\/bmj.n160","article-title":"PRISMA 2020 explanation and elaboration: Updated guidance and exemplars for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Higgins, J.P.T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M.J., and Welch, V.A. (2019). Cochrane Handbook for Systematic Reviews of Interventions, Wiley. [2nd ed.].","DOI":"10.1002\/9781119536604"},{"key":"ref_45","unstructured":"(2022, September 05). Covidence. Available online: http:\/\/www.covidence.org\/."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane Collaboration\u2019s tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"BMJ"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1136\/bmj.39490.551019.BE","article-title":"What is \u201cquality of evidence\u201d and why is it important to clinicians?","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: An emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.jclinepi.2017.05.006","article-title":"The GRADE Working Group clarifies the construct of certainty of evidence","volume":"87","author":"Hultcrantz","year":"2017","journal-title":"J. Clin. Epidemiol."},{"key":"ref_50","unstructured":"(2022, September 05). RevMan. Available online: https:\/\/training.cochrane.org\/online-learning\/core-software-cochrane-reviews\/revman."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e12635","DOI":"10.1111\/hel.12635","article-title":"Review: Epidemiology of Helicobacter pylori infection","volume":"24","author":"Leja","year":"2019","journal-title":"Helicobacter"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1128\/CMR.10.4.720","article-title":"Helicobacter pylori","volume":"10","author":"Dunn","year":"1997","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1002\/path.1868","article-title":"Helicobacter infection and gastric neoplasia","volume":"208","author":"Peek","year":"2006","journal-title":"J. Pathol."},{"key":"ref_54","first-page":"817","article-title":"Applicability of zinc complex of L-carnosine for medical use","volume":"65","author":"Matsukura","year":"2000","journal-title":"Biochemistry"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1080\/09674845.2014.11669962","article-title":"Zinc chloride inhibits Helicobacter pylori growth and reduces expression of interleukin-1beta by gastric epithelial cells","volume":"71","author":"Yakoob","year":"2014","journal-title":"Br. J. Biomed. Sci."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"383","DOI":"10.3109\/14756360903179518","article-title":"Mechanochemical synthesis and in vitro anti-Helicobacter pylori and uresase inhibitory activities of novel zinc(II)\u2013famotidine complex","volume":"25","author":"Amin","year":"2010","journal-title":"J. Enzyme Inhib. Med. Chem."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"105611","DOI":"10.1016\/j.micpath.2022.105611","article-title":"Comparative transcriptome analysis to investigate the mechanism of anti-Helicobacter pylori activity of zinc","volume":"168","author":"Fan","year":"2022","journal-title":"Microb. Pathog."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1146\/annurev.biochem.71.110601.135414","article-title":"Lipopolysaccharide endotoxins","volume":"71","author":"Raetz","year":"2003","journal-title":"Annu. Rev. Biochem."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1007\/s12011-014-9943-5","article-title":"Oral treatment of pressure ulcers with polaprezinc (zinc L-carnosine complex): 8-week open-label trial","volume":"158","author":"Sakae","year":"2014","journal-title":"Biol. Trace Elem. Res."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Chinese Study Group on Helicobacter pylori, Liu, W.Z., Xie, Y., Cheng, H., Lu, N.H., Hu, F.L., Zhang, W.D., Zhou, L.Y., Chen, Y., and Zeng, Z.R. (2013). Fourth Chinese National Consensus Report on the management of Helicobacter pylori infection. J. Dig. Dis., 14, 211\u2013221.","DOI":"10.1111\/1751-2980.12034"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1111\/hel.12287","article-title":"Hp-normogram (normo-graham) for assessing the outcome of H. pylori therapy: Effect of resistance, curation, and CYP2C19 genotype","volume":"21","author":"Graham","year":"2016","journal-title":"Helicobacter"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/14\/19\/4126\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:46:23Z","timestamp":1760143583000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/14\/19\/4126"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,4]]},"references-count":61,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["nu14194126"],"URL":"https:\/\/doi.org\/10.3390\/nu14194126","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,4]]}}}