Therapy: Clinical Scenario

A 68 year old retired physician consults you about an episode of severe dyspepsia on a background of 20 years of mild indigestion. She is overweight but otherwise in good health. She is taking omeprazole 20mg nocte, drinks 10 units of alcohol per week and takes naproxen for arthralgias two to three times per week. You perform an oesophago-gastro-duodenoscopy which reveals a small 5 cm hiatus hernia and mild antral gastritis but is otherwise normal. You take an antral biopsy and apply a CLO test for helicobacter pylori. This is strongly positive. Histological investigation confirms both gastritis and helicobacter infection.

You wonder if there is any new evidence about helicobacter eradication in patients with non-ulcer dyspepsia and formulate the question, In a patient with nonulcer dyspepsia and helicobacter pylori infection, will helicobacter eradication therapy result in a reduction in symptoms of dyspepsia?

You perform a MEDLINE search using the terms "nonulcer dyspepsia" and "helicobacter pylori" and "randomized controlled trial"
And retrieve two RCTs that appear to come to conflicting conclusions

Read the article and decide:

1. Is the evidence from this randomised trial valid?
2. If valid, is this evidence important?
3. If valid and important, can you apply this evidence in caring for your patient?

Then explain why the two trials come to different conclusions. What will you tell your patient?

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