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
- 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.
- Carbon-14 urea breath test used to preselect patients with evidence of Helicobacter pylori infection.
- Upper GI endoscopy confirmed diagnosis in all patients
- Analysis of symptoms 1 year after treatment
Appraised By
William Rosenberg 1999
Expiry Date
2000