Impact of Helicobacter pylori eradication on dyspepsia, health resource use, and quality of life in the Bristol helicobacter project: randomised controlled trial.
OBJECTIVE
To determine the impact of a community based Helicobacter pylori screening and eradication programme on the incidence of dyspepsia, resource use, and quality of life, including a cost consequences analysis.


METHODS
H pylori screening programme followed by randomised placebo controlled trial of eradication.


METHODS
Seven general practices in southwest England.


METHODS
10,537 unselected people aged 20-59 years were screened for H pylori infection (13C urea breath test); 1558 of the 1636 participants who tested positive were randomised to H pylori eradication treatment or placebo, and 1539 (99%) were followed up for two years.


METHODS
Ranitidine bismuth citrate 400 mg and clarithromycin 500 mg twice daily for two weeks or placebo.


METHODS
Primary care consultation rates for dyspepsia (defined as epigastric pain) two years after randomisation, with secondary outcomes of dyspepsia symptoms, resource use, NHS costs, and quality of life.


RESULTS
In the eradication group, 35% fewer participants consulted for dyspepsia over two years compared with the placebo group (55/787 v 78/771; odds ratio 0.65, 95% confidence interval 0.46 to 0.94; P = 0.021; number needed to treat 30) and 29% fewer participants had regular symptoms (odds ratio 0.71, 0.56 to 0.90; P = 0.05). NHS costs were 84.70 pounds sterling (74.90 pounds sterling to 93.91 pounds sterling) greater per participant in the eradication group over two years, of which 83.40 pounds sterling (146 dollars; 121 euro) was the cost of eradication treatment. No difference in quality of life existed between the two groups.


CONCLUSIONS
Community screening and eradication of H pylori is feasible in the general population and led to significant reductions in the number of people who consulted for dyspepsia and had symptoms two years after treatment. These benefits have to be balanced against the costs of eradication treatment, so a targeted eradication strategy in dyspeptic patients may be preferable.
Lane
J Athene
JA
Department of Social Medicine, University of Bristol, Bristol BS8 2PR. Athene.lane@bristol.ac.uk
Murray
Liam J
LJ
Noble
Sian
S
Egger
Matthias
M
Harvey
Ian M
IM
Donovan
Jenny L
JL
Nair
Prakash
P
Harvey
Richard F
RF
D000328:Adult; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000191:economics / Q000627:therapeutic use; D001729:Bismuth / Q000191:economics / Q000627:therapeutic use; D017291:Clarithromycin / Q000191:economics / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D004415:Dyspepsia / Q000175:diagnosis / Q000191:economics / Q000382:microbiology*; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000191:economics; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010437:Peptic Ulcer / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology; D011788:Quality of Life; D011899:Ranitidine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; C073340:ranitidine bismuth citrate; D011899:Ranitidine; D017291:Clarithromycin; D001729:Bismuth