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Centre for Evidence-
Based Medicine

Nonulcer dyspepsia - Helicobacter Eradication reduces the prevalence of symptoms

Clinical Bottom Line

Helicobacter pylori eradication in patients with nonulcer dyspepsia using omeprazole and two antibiotics for 2 weeks results in symptomatic improvement.

Citation

Symptomatic benefit from eradicating helicobacter pylori infection in patients with nonulcer dyspepsia. McColl K et al. N Engl J Med 1998;339:1869-74.

Clinical Question

In a patient with nonulcer dyspepsia and helicobacter pylori infection, will helicobacter eradication therapy result in a reduction in symptoms of dyspepsia?

Search Terms

"nonulcer dyspepsia" and "helicobacter pylori" and "randomised controlled trial" in MEDLINE

The Study

  • Double-blinded concealed randomised placebo controlled trial with intention-to-treat analysis.
  • Patients: adults referred with dyspepsia for =4 months, no previous or current peptic ulceration, oesophagitis or NSAID use.
  • Control group (N = 160: 160 analysed): placebos
  • Experimental group (N = 158; 158 analysed): 20mg omeprazole po; bd, amoxycillin 500mg po;tds, (or tetracycline 500mg po;tds for penecillin sensitivity), metronidazole 400mg po;tds all for 2 weeks VS omeprazole 20mg bd;po + placebo.

The Evidence

Outcome Time to Outcome CER EER RRR ARR NNT
Persisting symptoms 1 year 0.93 0.79 15% 0.14 7
95% Condidence Intervals 7.7% to 22.3% 4 to 14

Comments

  1. Dyspepsia defined as intermittent or persistent pain or discomfort in upper abdomen or lower chest, heartburn, nausea, postprandial fullness or any other upper GI symptom.
  2. Carbon-14 urea breath test used to preselect patients with evidence of Helicobacter pylori infection.
  3. Upper GI endoscopy confirmed diagnosis in all patients
  4. Analysis of symptoms 1 year after treatment

Appraised By

William Rosenberg 1999

Expiry Date

2000