Role of Orvosi Hetilap in the development of Hungarian gastroenterology

AIM:To analyze the contribution of Orvosi Hetilap(Hungarian Medical Journal) to the field of gastroenterology.METHODS:All issues of the journal between 1857 and 2008 and identified original articles and reviews dealing with gastroenterology were reviewed.The rate of publications,the thematic distribution and foreign sources of knowledge were assessed.The dates that major achievements in gastroenterology were introduced in Hungary were compared to those dates in Western medicine.RESULTS:A total of 4799 original/research articles on gastroenterology were published,which represents 11.1% of the total publications.Thematic rankings showed that liver and biliary diseases represented 20.36% of the total,followed by gastric diseases(9.35%) and surgery(8.77%).A total of 268 foreign journals were reviewed:50.9% were German,30.4% English,12.1% French and only 6.6% were in other languages.The major achievements of gastroenterology were introduced with varying delays compared to Western countries.CONCLUSION:Orvosi Hetilap has made a large contribution to the development of Hungarian gastroenterology.The high proportion of gastroenterology studies underlines the importance of digestive diseases in public health.

First-line eradication of Helicobacter pylori:Are the standard triple therapies obsolete? A different perspective

Studies concerning the eradication of Helicobacter pylori have resulted in a proliferation of meta-analyses. To date, there are 303 meta-analyses cited in PubMed, 113 dealing with the therapy of the infection. A chronological analysis of the results of meta-analyses performed between 1998 and 2010 shows that first-line standard triple therapies achieved eradication rates on an intention-to-treat basis of around 80%; prolonging treatment to 14, but not 10 d should improve the results. The proton pump inhibitors have a similar efficiency, and giving a double dose is more efficient than the standard doses of these drugs. Triple and quadruple therapies proved to be equivalent. Based on meta-analytical data, the decrease in efficiency over time cannot be substantiated: eradication rates < 80% followed from the introduction of triple therapies. As alternatives, ranitidine bismuth citrate-, levofloxacinor furazolidone-based therapies were shown to obtain the same eradication rates as standard triple regimens. Sequential therapies and quadruple non-bismuth-based therapies were superior to standard triple therapies but their use is limited to certain countries. In the author's opinion, and from a meta-analytical viewpoint, standard triple therapies cannot yet be considered obsolete. Furthermore, noninferiority trials are proposed for the future, including assessment of local contemporary antimicrobial resistance profi les and the CagA and CYP2C19 status of the enrolled patients.

Fate of meta-analyses: The case of Helicobacter pylori

AIM: To overview the current diversity of meta-analysis and the implementation of their results in international guidelines. METHODS: Relevant meta-analysis were identifiedfrom Pub Med/Medline. The topics of meta-analyses were determined. Some topics(genetics, extragastric tumors) were analysed separately. Core journals publishing meta-analyses on Helicobacter pylori were ranked. The rate of citation of meta-analysis in major guidelines was calculated. RESULTS: Between 1992 and 2014, some 356 metaanalyses were published on Pub Med. These mainly appeared in core journals, but were also found in 128 other journals. Eradicating of the infection was the most addressed topic with 134 articles. Meta-analyses were rarely used in formulating statements and recommendations in the international guidelines. In other topics- genetics, extraintestinal manifestations-meta-analyses were rather overused. CONCLUSION: The implementation of meta-analysis in current guidelines is rather rare, while other topics benefit from many studies. A more extensive use of metaanalyses in evidence-based medicine is recommended in the future, otherwise their continuous proliferation will lose reason and scientific significance.