Clinical trial: prolonged beneficial effect of Helicobacter pylori eradication on dyspepsia consultations - the Bristol Helicobacter Project.
BACKGROUND
Chronic infection of the stomach with Helicobacter pylori is widespread throughout the world and is the major cause of peptic ulcer disease and gastric cancer. Short-term benefit results from community programmes to eradicate the infection, but there is little information on cumulative long-term benefit.


OBJECTIVE
To determine whether a community programme of screening for and eradication of H. pylori infection produces further benefit after an initial 2-year period, as judged by a reduction in GP consultations for dyspepsia.


METHODS
A total of 1517 people aged 20-59 years, who were registered with seven general practices in Frenchay Health District, Bristol, had a positive (13)C-urea breath test for H. pylori infection and were entered into a randomized double-blind trial of H. pylori eradication therapy. After 2 years, we found a 35% reduction in GP consultations for dyspepsia (previously reported). In this extension to the study, we analysed dyspepsia consultations between two and 7 years after treatment.


RESULTS
Between two and 7 years after treatment, 81/764 (10.6%) of participants randomized to receive active treatment consulted for dyspepsia, compared with 106/753 (14.1%) of those who received placebo, a 25% reduction, odds ratio 0.84 (0.71, 1.00), P = 0.042.


CONCLUSIONS
Eradication of H. pylori infection in the community gives cumulative long-term benefit, with a continued reduction in the development of dyspepsia severe enough to require a consultation with a general practitioner up to at least 7 years. The cost savings resulting from this aspect of a community H. pylori eradication programme, in addition to the other theoretical benefits, make such programmes worthy of serious consideration, particularly in populations with a high prevalence of H. pylori infection.
Harvey
R F
RF
Frenchay Hospital, North Bristol Healthcare Trust, UK. richard.harvey1@virgin.net
Lane
J A
JA
Nair
P
P
Egger
M
M
Harvey
I
I
Donovan
J
J
Murray
L
L
D000328:Adult; D002908:Chronic Disease; D004311:Double-Blind Method; D004415:Dyspepsia / Q000175:diagnosis* / Q000191:economics / Q000517:prevention & control*; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000191:economics; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics; D008875:Middle Aged; D055815:Young Adult