Tailored Therapy vs. Empirical Therapy for Helicobacter pylori Eradication: An Umbrella Review of Systematic Reviews and Meta-Analyses

Objective: This study aimed to provide the first umbrella review to systematically evaluate the evidence for the efficacy of personalized susceptibility-guided tailored therapy (TT) versus empirical therapy (ET) for Helicobacter pylori eradication. Methods: An umbrella review was conducted following Joanna Briggs Institute standards, registered in PROSPERO (CRD420251104335). A comprehensive literature search across MEDLINE/PubMed, EMBASE, RSCI, and Google Scholar identified systematic reviews and meta-analyses published between 1 January 1985 and 10 June 2025. Studies comparing TT and ET were included. Methodological quality was assessed using a modified AMSTAR-2 tool, GRADE, and the risk of bias was evaluated using the ROBIS tool. Data were synthesized using a random-effects model, with heterogeneity assessed using the I2 statistic. Results: A total of 7 systematic reviews and meta-analyses were included, covering 66 primary studies. TT was associated with a significantly higher eradication rate compared to ET (RR = 1.265; 95% CI: 1.137–1.407). In first-line treatment, TT showed consistent superiority (RR = 1.156; 95% CI: 1.117–1.196), which was further supported by high-quality meta-analyses (RR = 1.288; 95% CI: 1.022–1.624). The benefit in second-line therapy did not reach statistical significance (RR = 1.291; 95% CI: 0.834–1.999). The absolute eradication rates were 84.31% (95% CI: 80.94–87.41) for TT and 67.80% (95% CI: 58.48–76.46) for ET. Conclusions: TT is more effective than ET in the first-line H. pylori eradication regimen. However, the benefit is less evident in second-line regimens.