Intervention Review

Helicobacter pylori eradication therapy vs. antisecretory non-eradication therapy (with or without long-term maintenance antisecretory therapy) for the prevention of recurrent bleeding from peptic ulcer

  1. Javier P Gisbert1,*,
  2. Sam Khorrami2,
  3. Fernando Carballo3,
  4. Xavier Calvet4,
  5. Emili Gené5,
  6. Enrique Dominguez-Muñoz6

Editorial Group: Cochrane Upper Gastrointestinal and Pancreatic Diseases Group

Published Online: 17 FEB 2010

Assessed as up-to-date: 22 JUN 2009

DOI: 10.1002/14651858.CD004062.pub2

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Additional Information

How to Cite

Gisbert JP, Khorrami S, Carballo F, Calvet X, Gené E, Dominguez-Muñoz E. Helicobacter pylori eradication therapy vs. antisecretory non-eradication therapy (with or without long-term maintenance antisecretory therapy) for the prevention of recurrent bleeding from peptic ulcer. Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD004062. DOI: 10.1002/14651858.CD004062.pub2.

Author Information

  1. 1

    Hospital Universitario de la Princesa and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain

  2. 2

    Hospital de Son Dureta, Gastroenterology, Mallorca, Spain

  3. 3

    Hospital Virgen de la Arrixaca, Gastroenterology, Valencia, Spain

  4. 4

    Hospital de Sabadell & Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Servei de Malalties Digestives, Sabadell, Spain

  5. 5

    Hospital de Sabadell. Institut Universitary Parc Taulí. Universitat Autónoma de Barcelona, Servei de Medicina, Sabadell, Spain

  6. 6

    Hospital Clinico Universitario, Gastroenterology, Santiago de Compostela (Coruña), Spain

*Javier P Gisbert, Hospital Universitario de la Princesa and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain. gisbert@meditex.es.

Publication History

  1. Publication Status: Stable (no update expected for reasons given in 'What's new')
  2. Published Online: 17 FEB 2010

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Abstract

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

Background

Peptic ulcer is the main cause for upper gastrointestinal haemorrhage, and Helicobacter pylori (H.pylori) infection is the main etiologic factor for peptic ulcer disease. Maintenance antisecretory therapy is the standard long-term treatment for patients with bleeding ulcers to prevent recurrent bleeding. The efficacy of H. pylori eradication for the prevention of rebleeding from peptic ulcer is unknown.

Objectives

To compare the efficacy of H. pylori eradication therapy vs. antisecretory non-eradication therapy (with or without long-term maintenance antisecretory therapy) for the prevention of recurrent bleeding from peptic ulcer.

Search methods

We searched the Cochrane Controlled Trials Register (the Cochrane Library issue 4, 2003), MEDLINE (January 1966 to January 2004), EMBASE (January 1988 to January 2004), CINAHL (January 1982 to January 2004), and reference lists of articles. We also conducted a manual search from several congresses. The search strategy was re-run in January 2005 and October 2008, but no new trials were found.

Selection criteria

Controlled clinical trials comparing the efficacy of H. pylori eradication therapy vs. antisecretory non-eradication therapy (with or without long-term maintenance antisecretory therapy) for the prevention of recurrent bleeding from peptic ulcer.

Data collection and analysis

Data extraction and quality assessment of studies was done by two reviewers. Study authors were contacted for additional information.

Main results

Seven studies with a total of 578 patients were included in the first comparison: mean percentage of rebleeding in H. pylori eradication therapy group was 2.9%, and in the non-eradication therapy group without subsequent long-term maintenance antisecretory therapy it was 20% (OR 0.17, 95% CI 0.10 to 0.32; there was no statistical evidence of heterogeneity; NNT was 7, 95% CI 5 to 11). Three studies with a total of 470 patients were included in the second comparison: mean percentage of rebleeding in H. pylori eradication therapy group was 1.6%, and in non-eradication therapy group with long-term maintenance antisecretory therapy it was 5.6% (OR 0.24, 95% CI 0.09 to 0.67; heterogeneity was not demonstrated; NNT was 20, 95% CI 12 to 100). Subgroup analyses were carried out to examine the effect of NSAIDS and of excluding H.pylori eradication failures from the analyses.

Authors' conclusions

Treatment of H. pylori infection is more effective than antisecretory non-eradication therapy (with or without long-term maintenance antisecretory therapy) in preventing recurrent bleeding from peptic ulcer. All patients with peptic ulcer bleeding should be tested for H. pylori infection, and eradication therapy should be prescribed to H. pylori-positive patients.

 

Plain language summary

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

Antibiotics vs. acid suppression therapy (with or without long-term maintenance acid suppression therapy) for the prevention of recurrent bleeding from peptic ulcer

Peptic ulcers are caused by acidic stomach juices damaging the lining of the stomach (gastric ulcer) or upper small intestine (duodenal ulcer). This causes pain, indigestion and sometimes bleeding. Bleeding in the gut can be life-threatening. Several treatments aim to heal the ulcer and prevent future bleeding. These include acid-suppressing drugs and antibiotics to treat Helicobacter pylori, a bacterium that causes most peptic ulcers. The review found that, for people who have had a bleeding peptic ulcer caused by Helicobacter pylori, treatment with antibiotics more effectively prevents gastrointestinal re-bleeding than acid-suppressing drugs. Antibiotics when Helicobacter pylori infection is present are also cheaper and more convenient than long-term acid-suppressing drugs.

 

摘要

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

背景

預防消化性潰瘍再出血，比較使用幽門螺旋桿菌根除治療與抗分泌非根除性治療(有或沒有長期維持抗分泌治療)

消化性潰瘍是上消化道出血的主要原因，幽門螺桿菌感染是消化性潰瘍的主要致病因素。長期維持抗分泌治療對出血性潰瘍預防再出血是標準治療，防止復發出血。另一方面，消滅幽門螺旋桿菌對於預防消化性潰瘍的再出血確切的療效則不明。

目標

預防消化性潰瘍再出血，比較使用幽門螺旋桿菌根除治療與抗分泌非根除性治療(有或沒有長期維持抗分泌治療)的療效

搜尋策略

我們搜查了Cochrane Controlled Trials Register (Cochrane圖書館第4期， 2003年) ，MEDLINE(1966年1月至2004年1月) ，EMBASE(1988年1月至2004年1月) ，CINAHL (1982年1月至2004年1月) ，並參考相關文獻。我們還進行了人工搜索許多會議。搜索策略在2005年1月重新運作，但沒有發現新的試驗。

選擇標準

預防消化性潰瘍再出血，以對照臨床試驗比較使用幽門螺旋桿菌根除治療與抗分泌非根除性治療(有或沒有長期維持抗分泌治療)的療效。

資料收集與分析

由兩個評審進行數據提取和研究的品質評估，並與研究作者員進行聯繫以獲得更多信息。

主要結論

7項研究共578例納入第一個整合分析：幽門螺旋桿菌根除治療組的平均再出血率為2.9 ％ ，而在非根除治療組且無長期抗分泌維持治療平均再出血率為20 ％ (勝算率為0.17 ，95 ％信賴區間為0.10 ～ 0.32 ;沒有非均質性的統計證據; NNT 為7 ，95 ％ 信賴區間為5至11)。三份研究報告，共470例，包括在第二次整合分析：幽門螺旋桿菌根除治療組的平均再出血率為為1.6 ％ ，而在非根除治療組且有長期抗分泌維持治療平均再出血率是5.6 ％ (勝算率為0.25 ， 95 ％信賴區間為0.08至0.76 ;且無異質性;NNT為20 ，95 ％ 信賴區間為12至100)。 次及分析中，若病人再出血時服用nonsteroidal antiinflammatory drugs (NSAIDs)，接受根除幽門螺桿菌治療其再出血率為2.7 ％ (第一個整合分析) ，或0.78 ％ (第二個整合分析)。當患者接受幽門螺旋桿菌根除治療而成功根除者，再出血率為1.1 ％ ，NNT由7減少至6 。在某些情況下，幽門螺旋桿菌復發感染是潰瘍再出血的原因。

作者結論

預防消化性潰瘍再出血，使用幽門螺旋桿菌根除治療比抗分泌非根除性治療(有或沒有長期維持抗分泌治療)有效得多，因此，所有患者消化性潰瘍出血應檢測幽門螺旋桿菌感染，而且幽門螺旋桿菌陽性患者應接受根除治療。

翻譯人

本摘要由臺中榮民總醫院周佳滿翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

幽門螺桿菌引起的消化性潰瘍出血，用抗生素治療比制酸劑治療能更有效地防止胃腸再出血，消化性潰瘍造成的原因是胃酸破壞胃黏膜(胃潰瘍)或上段小腸(十二指腸潰瘍)。這會導致疼痛，消化不良，有時甚至出血。腸道出血可危及生命。一些治療的目的是治愈潰瘍和防止再出血，這些措施包括制酸藥物和治療幽門螺旋桿菌抗生素，因幽門螺旋桿菌導致大多數胃潰瘍。審查發現，抗生素比制酸藥物更有效地防止消化性潰瘍患者的再出血。在幽門螺桿菌感染的情況下，抗生素與長期制酸藥物治療相比較，是更便宜和更方便的。

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