Allicin as add-on therapy for Helicobacter pylori infection: A systematic review and meta-analysis
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Abstract
Allicin (2-propene-1-sulfinothioic acid S-2-propenyl ester, diallyl thiosulfinate)
extracted from garlic, has proven activity against Helicobacter pylori (H. Pylori)
infection. In recent years, clinical trials have explored its utility as an add-on
therapy with variable outcomes reported.
To perform a systemic review of allicin as an add-on treatment for H. Pylori
infection and assess its efficacy in randomized controlled trials (RCTs).
Electronic databases including MEDLINE, EMBASE, the Web of Science, the
Cochrane Database, the China National Knowledge Infrastructure Database,
Chinese VIP Information Databases, Chinese Medical Databases, and the Wan-
Fang Database were searched for keywords including “allicin”, “Helicobacter
pylori”, “randomized clinical trials”, and their synonyms. A meta-analysis was
performed using the fixed-effects model for low heterogeneity and the randomeffects
model for high heterogeneity with sensitivity analysis. Bias was evaluated
using Egger’s tests. Trial sequential analysis (TSA) was used to evaluate
information size and treatment benefits. The Grading of Recommendations
Assessment, Development and Evaluation (GRADE) was used to assess the level
of quality, and studies were classed as “high quality”, “moderate quality”, “low
quality”, and “very low quality”.
A total of eight RCTs consisting of 867 participants (435 from the allicin group
and 432 from the control group) were included. Eradication rate in the allicin group (93.33%, 406/435) was significantly higher than that of the control group
(83.56%, 361/432) [I2 = 0%, odds ratio (OR) = 2.75, 95% confidence interval (CI):
1.74-4.35, P < 0.001]. The healing rate of ulcers following H. pylori therapy in the
allicin group (86.17%, 349/405) was significantly higher than that of the control
group (75.87%, 305/402) [I2 = 0%, OR = 2.05, 95%CI: 1.39-3.03, P < 0.001]. The
total remission rate of peptic ulcers across all allicin groups was 95.99%, which
was significantly higher than that of controls [95.99% (359/374) vs 89.25%
(332/372), I2 = 0, heterogeneity P = 0.84, OR = 3.13, 95%CI: 1.51-6.51, P =0.002].
No significant differences in side effects were observed. TSA suggested that the
trials were of sufficient standard to draw reliable conclusions. The quality of
outcomes including eradication rates and side effects was graded as “very low”
due to downgrades for “risk of bias” and “indirectness”. Other outcomes such as
ulcer healing rates and total ulcer remission rates were graded as "low" due to downgrades for “risk of bias”.
Allicin as an add-on therapy improves H. pylori eradication, healing of ulcers, and
remission of symptoms. These results are suggested to be treated with caution
due to limited quality.
Source:https://pubmed.ncbi.nlm.nih.gov/31660038/