Therapy for Helicobacter pylori in patients with nonulcer dyspepsia. A meta-analysis of randomized, controlled trials.
OBJECTIVE
To assess the effect of eradication therapy for Helicobacter pylori on symptoms of nonulcer dyspepsia.


METHODS
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.


METHODS
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.


METHODS
Independent, duplicate data extraction of the methodologic quality, population, intervention, study design, duration, and outcome of the trials.


RESULTS
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.


CONCLUSIONS
This meta-analysis provides little support for the use of H. pylori eradication therapy in patients with nonulcer dyspepsia.
Gastrointestinal Division, Department of Medicine, University of Southern California School of Medicine, 2025 Zonal Avenue, Los Angeles, CA 90033, USA.
L
L
Laine
P
P
Schoenfeld
M B
MB
Fennerty
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004415:Dyspepsia / Q000188:drug therapy* / Q000382:microbiology*; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D016017:Odds Ratio; D009942:Organometallic Compounds / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D009942:Organometallic Compounds; C002791:bismuth tripotassium dicitrate