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Therapy for Helicobacter pylori in Patients with Nonulcer Dyspepsia
A Meta-Analysis of Randomized, Controlled Trials
- Loren Laine, MD;
- Philip Schoenfeld, MD, MSEd, MSc; and
- M. Brian Fennerty, MD
- From University of Southern California School of Medicine, Los Angeles, California; University of Michigan School of Medicine and Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan; and Oregon Health Sciences University, Portland, Oregon.
Abstract
Purpose: To assess the effect of eradication therapy for Helicobacter pylori on symptoms of nonulcer dyspepsia.
Data Sources: Duplicate searches of bibliographic databases, reviews of proceedings of annual gastroenterology and H. pylori meetings from 1995 to 1999, reviews of reference lists, and contact with primary investigators and pharmaceutical manufacturers.
Study Selection: Included studies 1) examined patients with nonulcer dyspepsia and H. pylori infection; 2) used combination therapy for H. pylori and a control therapy without efficacy against H. pylori; 3) were randomized, controlled trials; 4) lasted for at least 1 month after the end of therapy; and 5) assessed symptoms of nonulcer dyspepsia. Ten studies were included.
Data Extraction: Independent, duplicate data extraction of the methodologic quality, population, intervention, study design, duration, and outcome of the trials.
Data Synthesis: The odds ratio (OR) for treatment success in nonulcer dyspepsia with H. pylori eradication therapy compared with control therapy was 1.29 (95% CI, 0.89 to 1.89; P = 0.18). However, significant heterogeneity (P = 0.04) calls the validity of aggregating the data into question. Heterogeneity resolved with the exclusion of one study (OR, 1.07 [CI, 0.83 to 1.37]; P > 0.2). For predefined analysis of trials that used a specifically stated definition of dyspepsia (that is, upper abdominal pain or discomfort), the OR was 1.04 (CI, 0.80 to 1.35) without heterogeneity. For treatment that resulted in cure rather than persistent infection, the OR was 1.17 (CI, 0.87 to 1.59) without heterogeneity.
Conclusion: This meta-analysis provides little support for the use of H. pylori eradication therapy in patients with nonulcer dyspepsia.
- Helicobacter pylori
- Dyspepsia
- Gastritis
- Pathological conditions, signs and symptoms
- Outcome and process assessment (health care)
Article and Author Information
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Acknowledgments: The authors thank Bruce Weaver, MSc, of the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, for statistical support.
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Current Author Addresses: Dr. Laine: Gastrointestinal Division, Department of Medicine, University of Southern California School of Medicine, 2025 Zonal Avenue, Los Angeles, CA 90033.
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Dr. Schoenfeld: Division of Gastroenterology, University of Michigan School of Medicine, and Division of Health Services Research, Ann Arbor Veterans Affairs Medical Center, VAMC 111-D, 2215 Fuller Road, Ann Arbor, MI 48105.
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Dr. Fennerty: Division of Gastroenterology (PV-310), Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97201.
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Author Contributions: Conception and design: L. Laine, P. Schoenfeld, M.B. Fennerty.
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Analysis and interpretation of the data: L. Laine, P. Schoenfeld, M.B. Fennerty.
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Drafting of the article: L. Laine, P. Schoenfeld, M.B. Fennerty.
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Critical revision of the article for important intellectual content: L. Laine, P. Schoenfeld, M.B. Fennerty.
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Final approval of the article: L. Laine, P. Schoenfeld, M.B. Fennerty.
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Provision of study materials or patients: L. Laine, M.B. Fennerty.
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Statistical expertise: L. Laine, P. Schoenfeld.
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Administrative, technical, or logistic support: L. Laine, P. Schoenfeld.
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Collection and assembly of data: L. Laine, M.B. Fennerty.
- Copyright ©2004 by the American College of Physicians
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