Ford, A.; Delaney, B.; Moayyed, P.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA17
Academic Journal
Introduction: H pylori eradication (HE) therapy is regarded as the treatment of choice for both duodenal (DU) and gastric ulcer (GU). Surprisingly there have been few systematic reviews on the efficacy of this approach both for acute healing and maintenance. Methods: The Cochrane Controlled Trials Register, Medline, EMBASE, and CINAHL electronic databases were searched for RCTs evaluating predefined HE therapies in DU and GU. Comparison therapies were ulcer healing drugs (UHD) or placebo/no therapy. Experts in the field and pharmaceutical companies were contacted for information on any unpublished RCTs. Articles were included on predefined eligibility and validity criteria. Results: 82 articles were reviewed, 57 were eligible, and data was extractable in 52 papers. The results are given in the table in terms of relative risk (RR) of ulcer unhealed/relapsed. Where statistically significant heterogeneity (p < 0.2) existed (denoted by *) a random effects model was used (see Table). The pooled relapse rate for DU recurrence in those allocated to no treatment over 12-52 weeks was 60% compared with 14% in the HE group. The corresponding figures for GU patients were 45% and 12%. Meta-regression was performed to evaluate factors that might explain the heterogeneity in the DU and GU maintenance meta-analyses. Eradication rate was not a significant factor in this mode[ with only concealment of allocation an independent predictor of trial outcome. Conclusions: HE is an effective therapy to prevent DU and GU recurrence although the efficacy of this may be overestimated and there is variability in study results not explained by efficacy of eradication. HE has additional benefit to UHD in healing DU (but not GU) patients.


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