Review - Document Details

 



Review - Reviewer's Assessment

1. Short summary / abstract
Objectives To determine the effect of H.pylori eradication on dyspepsia symptoms and quality of life scores in patients with non-ulcer dyspepsia.
Selection Criteria All parallel group randomised controlled trials (RCTs) comparing drugs to eradicate H.pylori with placebo or other drugs known not to eradicate H.pylori for patients with non-ulcer dyspepsia.
Data collection and analysis Data were collected on individual and global dyspeptic symptom scores, quality of life measures and adverse effects. Dyspepsia outcomes were dichotomised into minimal/resolved versus same/worse symptoms.
Main Results Fifteen randomised controlled trials were included in the systematic review. Thirteen trials compared antisecretory dual or triple therapy with placebo antibiotics +/- antisecretory therapy, and evaluated dyspepsia at 3-12 months. Twelve of these trials gave results as dichotomous outcomes evaluating 2,903 patients and there was no significant heterogeneity between the studies. There was a 9% relative risk reduction in the H.pylori eradication group (95% CI = 5% to 14%) compared to placebo. The number needed to treat to cure one case of dyspepsia = 15 (95% CI = 10 to 28). A further two trials compared Bismuth based H.pylori eradication with an alternative pharmacological agent. These trials were smaller and had a shorter follow-up but suggested H.pylori eradication was more effective than either H2 receptor antagonists or sucralfate in treating non-ulcer dyspepsia.
Reviewers' conclusions H.pylori eradication therapy has a small but statistically significant effect in H.pylori positive non-ulcer dyspepsia. An economic model suggests this modest benefit may still be cost-effective but more research is needed.


2. What question is the document addressing?
Does H. pylori eradication therapy improve symptoms in non-ulcer dyspepsia?

3. Type of study
Systematic review

4. Methods valid & appropriate?
Yes

Comments:
The authors have performed a very thorough review with an extensive search and good selection and appraisal procedures.

5. Results / recommendations reliable?
Good methodology has produced reliable results.There was no significant heterogeneity between studies and, therefore, it was appropriate to combine the results. The reviewers contacted the original authors when ever doubt existed.

6. Any major problems and biases?
None. Publication bias does not appear to be a problem as there was no funnel plot asymmetry and many of the papers were negative trials.

7. Any other important / relevant studies which confirm or contradict?
Many individual studies have not shown a significant difference between those treated and those who receive placebo. It has taken this systematic review and meta-analysis to show that a small, but statistically significant, difference exists.

8. Keywords




Reviewer's Details:

Name:Tim Weller
Post:Consultant Microbiologist
Affiliations
(Society / Organisation / Advisory Committee):
City Hospital, Birmingham and a member of the BSAC (http://www.bsac.org.uk/


*** Note: These are the views of a professional expert rather than an official statement from his or her society, organisation or advisory committee.






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