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Efficacy of Helicobacter pylori eradication therapy for functional dyspepsia: updated systematic review and meta-analysis.
Ford, Alexander C; Tsipotis, Evangelos; Yuan, Yuhong; Leontiadis, Grigorios I; Moayyedi, Paul.
Afiliación
  • Ford AC; Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK alexf12399@yahoo.com.
  • Tsipotis E; Leeds Institute of Medical Research, University of Leeds, Leeds, UK.
  • Yuan Y; Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Leontiadis GI; Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
  • Moayyedi P; Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Gut ; 2022 Jan 12.
Article en En | MEDLINE | ID: mdl-35022266
ABSTRACT

OBJECTIVE:

Functional dyspepsia (FD) is a chronic disorder that is difficult to treat. Helicobacter pylori may contribute to its pathophysiology. A Cochrane review from 2006 suggested that eradication therapy was beneficial, but there have been numerous randomised controlled trials (RCTs) published since. We evaluated impact of eradication therapy on both cure and improvement of FD, as well as whether any benefit was likely to arise from eradication of H. pylori.

DESIGN:

We searched the medical literature through October 2021 to identify RCTs examining efficacy of eradication therapy in H. pylori-positive adults with FD. The control arm received antisecretory therapy or prokinetics, with or without placebo antibiotics, or placebo alone. Follow-up was for ≥3 months. We pooled dichotomous data to obtain a relative risk (RR) of symptoms not being cured or symptoms not improving with a 95% CI. We estimated the number needed to treat (NNT).

RESULTS:

Twenty-nine RCTs recruited 6781 H. pylori-positive patients with FD. Eradication therapy was superior to control for symptom cure (RR of symptoms not being cured=0.91; 95% CI 0.88 to 0.94, NNT=14; 95% CI 11 to 21) and improvement (RR of symptoms not improving=0.84; 95% CI 0.78 to 0.91, NNT=9; 95% CI 7 to 17). There was no significant correlation between eradication rate and RR of FD improving or being cured (Pearson correlation coefficient=-0.23, p=0.907), but the effect was larger in patients with successful eradication of H. pylori than with unsuccessful eradication (RR=0.65; 95% CI 0.52 to 0.82, NNT=4.5, 95% CI 3 to 9). Adverse events (RR=2.19; 95% 1.10 to 4.37) and adverse events leading to withdrawal (RR=2.60; 95% CI 1.47 to 4.58) were more common with eradication therapy.

CONCLUSION:

There is high quality evidence to suggest that H. pylori eradication therapy leads to both cure and improvement in FD symptoms, although the benefit is modest.
Palabras clave

Texto completo: 1 Bases de datos: MEDLINE Tipo de estudio: Clinical_trials / Etiology_studies / Systematic_reviews Idioma: En Revista: Gut Año: 2022 Tipo del documento: Article País de afiliación: Reino Unido

Texto completo: 1 Bases de datos: MEDLINE Tipo de estudio: Clinical_trials / Etiology_studies / Systematic_reviews Idioma: En Revista: Gut Año: 2022 Tipo del documento: Article País de afiliación: Reino Unido