This is not the most recent version of the article. View current version (16 FEB 2011)

Intervention Review

Eradication of Helicobacter pylori for non-ulcer dyspepsia

  1. Paul Moayyedi1,
  2. Shelly Soo2,
  3. Jonathan J Deeks3,
  4. Brendan Delaney4,
  5. Adam Harris5,
  6. Michael Innes6,
  7. R Oakes7,
  8. Sue Wilson8,
  9. A Roalfe9,
  10. Cathy Bennett10,
  11. David Forman11

Editorial Group: Cochrane Upper Gastrointestinal and Pancreatic Diseases Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 13 FEB 2006

DOI: 10.1002/14651858.CD002096.pub4

Database Title

Additional Information

How to Cite

Author Information

  1. 1

    McMaster University, Department of Medicine, Gastroenterology Division, Hamilton, Ontario, Canada

  2. 2

    South Tyneside District Hosiptal, Department of Medicine/Gastroenterology, South Shields, UK

  3. 3

    University of Birmingham, Department of Public Health and Epidemiology, Birmingham, UK

  4. 4

    Primary Care and Clinical Sciences Building, Department of Primary Care and General Practice, Birmingham, West Midlands, UK

  5. 5

    Kent and Sussex Hospital, GI Department, Tunbridge Wells, Kent, UK

  6. 6

    The University of Birmingham, Department of Primary Care and General Practice, Birmingham, UK

  7. 7

    The Medical School, Department of General Practice, Birmingham, West Midlands, UK

  8. 8

    The Medical School, Dept of Primary Care and General Practice, Birmingham, UK

  9. 9

    The University of Birmingham, Department of General Practice, Birmingham, UK

  10. 10

    University of Leeds, Cochrane UGPD Group, Leeds, West Yorkshire, UK

  11. 11

    University of Leeds, Centre for Epidemiology and Biostatistics, Leeds, UK

Publication History

  1. Published Online: 21 JAN 2009

SEARCH

ARTICLE TOOLS

This is not the most recent version of the article.View current version (16 Feb 2011)

View Full Article (HTML) Full (427K)
 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

Helicobacter pylori (H pylori) is the main cause of peptic ulcer disease. The role of H pylori in non-ulcer dyspepsia is less clear.

Objectives

To determine the effect of H pylori eradication on dyspepsia symptoms in patients with non-ulcer dyspepsia.

Search strategy

Trials were identified through electronic searches of the Cochrane Controlled Trials Register (CCTR), MEDLINE, EMBASE, CINAHL and SIGLE, using appropriate subject headings and keywords, searching bibliographies of retrieved articles, and through contacts with experts in the fields of dyspepsia and with pharmaceutical companies.

Selection criteria

All parallel group randomised controlled trials (RCTs) comparing drugs to eradicate H pylori with placebo or other drugs known not to eradicate H pylori for patients with non-ulcer dyspepsia.

Data collection and analysis

Data were collected on individual and global dyspeptic symptom scores, quality of life measures and adverse effects. Dyspepsia outcomes were dichotomised into minimal/resolved versus same/worse symptoms.

Main results

Twenty one randomised controlled trials were included in the systematic review. Eighteen trials compared antisecretory dual or triple therapy with placebo antibiotics +/- antisecretory therapy, and evaluated dyspepsia at 3-12 months. Seventeen of these trials gave results as dichotomous outcomes evaluating 3566 patients and there was no significant heterogeneity between the studies. There was a 10% relative risk reduction in the H pylori eradication group (95% CI = 6% to 14%) compared to placebo. The number needed to treat to cure one case of dyspepsia = 14 (95% CI = 10 to 25). A further three trials compared Bismuth based H pylori eradication with an alternative pharmacological agent. These trials were smaller and had a shorter follow-up but suggested H pylori eradication was more effective than either H2 receptor antagonists or sucralfate in treating non-ulcer dyspepsia.

Authors' conclusions

H pylori eradication therapy has a small but statistically significant effect in H pylori positive non-ulcer dyspepsia. An economic model suggests this modest benefit may still be cost-effective but more research is needed.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Antibiotics to clear H. pylori infection may relieve indigestion that is not caused by ulcers, but more research is needed

Dyspepsia (indigestion or heartburn) is due to ulcers (stomach or duodenal) and acid in the gullet (oesophagus) but in many people the cause is uncertain. People without a cause for dyspepsia have non-ulcer dyspepsia. There is no clear evidence on the best treatment for this. Helicobacter pylori is a bacterium that infects the stomach. It is not cleared by the body and remains a life long infection unless treated with antibiotics. Helicobacter pylori causes most peptic ulcers but it is uncertain whether it has any role in non-ulcer dyspepsia. This review found that antibiotics for H pylori have a small benefit in treating non ulcer dyspepsia.

View Full Article (HTML) Full (427K)