Helicobacter pylori Eradication in Older Individuals: A Systematic Review and Meta‐Analysis

BACKGROUND: To determine the clinical effects, efficacy, adverse events, tolerance, and antibiotic resistance of Helicobacter pylori (H. pylori) eradication therapy in the elderly. MATERIALS AND METHODS: We searched Medline, Embase, CINAHL, Cochrane Library, clinical trial registry, conference proceedings portal, and citation screening. We selected randomized controlled trials (RCTs) or cohort designs including participants aged 60 years or older and reported their clinical effects or efficacy as quantitative indices. Meta-analyses were performed using a random effects model. RESULTS: A total of 5172 studies were identified, of which 64 were selected for review. The pooled eradication rate of the 10-day sequential therapy was 91% (95% confidence interval [CI], 86%-93%) and that of the 7-day standard triple therapy was 81% (95% CI, 77%-85%). In addition, 7-day levofloxacin-based TT, 14-day hybrid, 14-day bismuth-based QT, 7-day vonoprazan-based TT, and 14-day TT-PAC regimen in RCTs, and non-bismuth-based QT and susceptibility-based therapy in cohort studies showed eradication rates ≥ 95%. The most prevalent gastrointestinal adverse event varied by regimens, with compliance ranging from 87% to 100%. When populations with a history of eradication were included, antibiotic resistance rates exceeded the national prevalence. Three cohorts (the United States, South Korea, and China) reported a protective effect against gastric cancer, although this varied by index and age subgroup. CONCLUSIONS: In the eradication therapy of H. pylori in individuals aged 60 years or older, the 7-day standard triple therapy was unacceptable, and the 10-day sequential therapy was borderline acceptable. The eradication history should be assessed as it may contribute to antibiotic resistance. Although positive reports have emerged regarding the protective effects of gastric cancer on that population, country-specific and conditional recommendations are necessary. Future researchers should report more rigorously on adverse events, tolerance, and antibiotic resistance. PROTOCOL REGISTRATION: CRD42024617327.