Combination Therapies Commonly Used for Stomach Ulcers Are Probably Not Useful for Treating Stomach Discomfort

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The summary below is from the full report titled "Therapy for Helicobacter pylori in Patients with Nonulcer Dyspepsia. A Meta-Analysis of Randomized, Controlled Trials." It is in the 6 March 2001 issue of Annals of Internal Medicine (volume 134, pages 361-369). The authors are L Laine, P Schoenfeld, and MB Fennerty.

What is the problem and what is known about it so far?

Dyspepsia is stomach pain or discomfort. Often, it is not due to sores in the stomach lining (ulcers) or to acid washing up from the stomach into the esophagus (reflux). It is known that infection with the bacteria Helicobacter pylori (H. pylori) causes some stomach ulcers. We do not know whether H. pylori can also cause dyspepsia in patients without ulcers. Combinations of antibiotics and medicines that decrease the amount of stomach acid can cure ulcers caused by H. pylori. We do not know whether this therapy can cure dyspepsia in patients without ulcers.

Why did the researchers do this particular study?

To see if combination therapies that cure H. pylori ulcers work for dyspepsia.

Who was studied?

The study included people with H. pylori infection and dyspepsia not due to ulcer disease.

How was the study done?

Rather than doing a new study, the researchers used a technique called meta-analysis to combine information from 10 selected previous studies. For a study to be included, it must have assigned patients at random to receive either combination therapies for H. pylori or therapies that were not active against H. pylori infection. Most of the combination therapies included three drugs. Treatment lasted for 1 to 2 weeks. The researchers asked patients about dyspepsia symptoms 6 weeks to 2 years after treatment, depending on the particular study.

What did the researchers find?

Patients who received combination therapy did not show improvement in dyspepsia symptoms compared with patients who did not receive H. pylori therapy. Some studies provided information on cure of infection after treatment. In these studies, improvement in dyspepsia did not differ between the two treatment groups, regardless of whether the infection was cured.

What were the limitations of the study?

The studies that the researchers included used different definitions of dyspepsia, different treatment regimens, and different methods to monitor patients. Although 10 studies were combined, there were still too few patients to rule out the possibility that some combination therapies may have had small benefits.

What are the implications of the study?

Combination therapies for H. pylori infection are probably not useful for treating dyspepsia.