According to a systematic review and meta-analysis published in "Therapeutic Advances in Gastroenterology", high-dose dual therapy (HDDT) is as effective as bismuth-containing quadruple therapy (BQT) in eliminating Helicobacter pylori (H. pylori), with fewer adverse effects and comparable compliance. Investigators sought to compare the effectiveness of HDDT and BQT in the treatment of H. pylori. All randomised controlled trials (RCTs) comparing HDDT and BQT's efficacy in the elimination of H. pylori were gathered by searching Embase, PubMed, and the Cochrane library database.

A random-effects model was used in the meta-analysis to procure the pooled relative risk (RR) with 95% confidence intervals (CIs). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to determine the quality of the evidence. To assess the validity and precision, trial sequential analysis (TSA) was performed. Overall, 14 RCTs with 5121 patients were incorporated.

As found, there was no statistically significant difference between HDDT and BQT in terms of H. pylori elimination rate (intention-to-treat analysis: 86.7% versus 85.1%; per-protocol analysis: 89.9% versus 89.4%, RR = 1.01; moderate-quality evidence). The incidence of total negative effects was considerably lower in the HDDT group than the BQT group (5.9% versus 34.1%, RR = 0.42; low-quality evidence). HDDT and BQT compliance was not statistically significant (RR = 1.01, low-quality evidence).

As per the TSA findings of H. pylori elimination rate, the effect was irrefutable. Hence, compared with BQT, HDDT exerts comparable compliance and effectiveness, with fewer adverse effects in eliminating H. pylori.