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Eradicating H. pylori May Help Nonulcer Dyspepsia

Although eradication of H. pylori clearly helps in the treatment of ulcers, the value of this therapy is less clear in dyspeptic patients who have no evidence of ulcer but who harbor the organism. Recent studies have provided conflicting results, leading these U.K. investigators to perform this meta-analysis and cost-effectiveness analysis of H. pylori eradication in nonulcer dyspepsia.

Nine randomized trials were evaluated: They included 2541 patients who were followed for 3 to 12 months after eradication. Three trials showed a statistically significant benefit for H. pylori eradication, and 6 showed no benefit. Results from 5 of the trials have been published fully, but results from 4 have appeared only in abstract form. At 1 year, the mean placebo response rate was 28 percent, compared with 36 percent for eradication treatment. The number of patients needed to treat to cure 1 case of dyspepsia was 15. The 3 trials that evaluated quality of life showed no effect for treatment. The cost analysis showed that eradication would cost 32 pounds ($47) more per patient per year than would antacid treatment.

Comment: This analysis reveals a statistically significant but modest effect for H. pylori eradication on nonulcer dyspepsia. An editorialist notes that persistence of benefit beyond 1 year would make this strategy more cost-effective. Meanwhile, the measured cost-effectiveness at 1 year might seem attractive to some patients but not to others.

— KI Marton

Published in Journal Watch General Medicine October 17, 2000

Citation(s):

Moayyedi P et al. Systematic review and economic evaluation of Helicobacter pylori eradication treatment for non-ulcer dyspepsia. BMJ 2000 Sep 16 321 659 -664.

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• Medline abstract (Free)

Veldhuyzen van Zanten SJO. Treating non-ulcer dyspepsia and H pylori: It is economically and clinically sensible but it won't make most patients better. BMJ 2000 Sep 16 321 648 -649.

• Original article (Subscription may be required)
• Medline abstract (Free)