scholarly journals Helicobacter pylori Eradication Therapy for Functional Dyspepsia: A Meta-Analysis by Region and H. pylori Prevalence

2019 ◽  
Vol 8 (9) ◽  
pp. 1324 ◽  
Author(s):  
Seung Joo Kang ◽  
Boram Park ◽  
Cheol Min Shin
Keyword(s):  
Helicobacter Pylori ◽  
Functional Dyspepsia ◽  
Meta Analysis ◽  
Eradication Therapy ◽  
Cochrane Library ◽  
Control Group ◽  
Number Needed To Treat ◽  
Helicobacter Pylori Eradication ◽  
Dyspeptic Symptoms ◽  
H Pylori

Background: Previous studies on the effect of Helicobacter pylori eradication on functional dyspepsia (FD) are conflicting. We performed a comprehensive meta-analysis on this issue according to region and prevalence of H. pylori. Methods: Randomized controlled trials (RCTs) evaluating the effect of eradication of H. pylori on functional dyspepsia up to December 2018 were searched through PubMed, EMBASE, and the Cochrane Library. Subgroup analyses by the outcome measure, region, and prevalence of H. pylori were performed. All data were analyzed with Review Manager 5.3. Results: Eighteen RCTs were included in our meta-analysis. Overall, the H. pylori eradication group showed significant improvement of symptoms compared with the control group (risk ratio (RR) = 1.18; 95% confidence interval (CI): 1.07–1.30, p < 0.01). There was moderate heterogeneity among studies (I2 = 34%) and the number needed to treat (NNT) was 15.0. Helicobacter pylori eradication improved dyspeptic symptoms both in low (<50%) and high (≥50%) H. pylori prevalence regions (RR = 1.21 and 1.17; 95% CI: 1.02–1.44 and 1.06–1.29, I2 = 49% and 5%, respectively.) In the analysis of studies from Asia, however, the effect of eradication on improvement of dyspepsia was not significant (RR = 1.14; 95% CI: 0.99–1.33, p = 0.08, I2 = 37%). Conclusion: Overall, H. pylori eradication provides significant improvement of symptoms in functional dyspepsia patients regardless of H. pylori prevalence. However, in the analysis of studies from Asia, the eradication did not significantly improve dyspeptic symptoms. In this region, eradication for dyspepsia can be individualized.

scholarly journals Efficacy of Helicobacter pylori eradication therapy for functional dyspepsia: updated systematic review and meta-analysis

Gut ◽  
2022 ◽  
pp. gutjnl-2021-326583
Author(s):  
Alexander C Ford ◽  
Evangelos Tsipotis ◽  
Yuhong Yuan ◽  
Grigorios I Leontiadis ◽  
Paul Moayyedi
Keyword(s):  
Helicobacter Pylori ◽  
Adverse Events ◽  
Functional Dyspepsia ◽  
Meta Analysis ◽  
Pearson Correlation ◽  
Cochrane Review ◽  
Eradication Therapy ◽  
Number Needed To Treat ◽  
H Pylori ◽  
Randomised Controlled

ObjectiveFunctional dyspepsia (FD) is a chronic disorder that is difficult to treat. Helicobacter pylori may contribute to its pathophysiology. A Cochrane review from 2006 suggested that eradication therapy was beneficial, but there have been numerous randomised controlled trials (RCTs) published since. We evaluated impact of eradication therapy on both cure and improvement of FD, as well as whether any benefit was likely to arise from eradication of H. pylori.DesignWe searched the medical literature through October 2021 to identify RCTs examining efficacy of eradication therapy in H. pylori-positive adults with FD. The control arm received antisecretory therapy or prokinetics, with or without placebo antibiotics, or placebo alone. Follow-up was for ≥3 months. We pooled dichotomous data to obtain a relative risk (RR) of symptoms not being cured or symptoms not improving with a 95% CI. We estimated the number needed to treat (NNT).ResultsTwenty-nine RCTs recruited 6781 H. pylori-positive patients with FD. Eradication therapy was superior to control for symptom cure (RR of symptoms not being cured=0.91; 95% CI 0.88 to 0.94, NNT=14; 95% CI 11 to 21) and improvement (RR of symptoms not improving=0.84; 95% CI 0.78 to 0.91, NNT=9; 95% CI 7 to 17). There was no significant correlation between eradication rate and RR of FD improving or being cured (Pearson correlation coefficient=−0.23, p=0.907), but the effect was larger in patients with successful eradication of H. pylori than with unsuccessful eradication (RR=0.65; 95% CI 0.52 to 0.82, NNT=4.5, 95% CI 3 to 9). Adverse events (RR=2.19; 95% 1.10 to 4.37) and adverse events leading to withdrawal (RR=2.60; 95% CI 1.47 to 4.58) were more common with eradication therapy.ConclusionThere is high quality evidence to suggest that H. pylori eradication therapy leads to both cure and improvement in FD symptoms, although the benefit is modest.

scholarly journals Endoscopic Reflux Esophagitis and Reflux-Related Symptoms after Helicobacter pylori Eradication Therapy: Meta-Analysis

2020 ◽  
Vol 9 (9) ◽  
pp. 3007 ◽  
Author(s):  
Mitsushige Sugimoto ◽  
Masaki Murata ◽  
Hitomi Mizuno ◽  
Eri Iwata ◽  
Naoyoshi Nagata ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Reflux Esophagitis ◽  
Reflux Disease ◽  
Meta Analysis ◽  
Eradication Therapy ◽  
Case Group ◽  
Inclusion Criteria ◽  
Helicobacter Pylori Eradication ◽  
Significant Difference ◽  
H Pylori

Backgrounds: The etiology of gastroesophageal reflux disease (GERD) including reflux esophagitis and non-erosive reflux disease is multifactorial and a recent meta-analysis showed no association between the development of GERD and Helicobacter pylori eradication in both Western and East-Asian populations. However, the problem remains that various inclusion criteria are used in these studies, which hinders meta-analysis. With a focus on reflux esophagitis with endoscopic mucosal injury, we meta-analysed to evaluate the association between eradication and reflux esophagitis and symptoms using a clearly defined set of inclusion criteria. Methods: We conducted a meta-analysis of studies published up until March 2020, which compared the incidence of reflux esophagitis and symptoms between patients undergoing H. pylori eradication therapy in a randomized placebo-controlled trial (Category A); between patients with successful and failed eradication (Category B); and between patients with successful vs. failed eradication, receipt of placebo, or no-treatment H. pylori-positives (Category C). Results: A total of 27 studies were included. Significant statistical effects were found for development of endoscopic reflux esophagitis [relative risk (RR): 1.46, 95% confidence interval (CI): 1.16–1.84, p = 0.01] or de novo reflux esophagitis (RR: 1.42, 95% CI: 1.01–2.00, p = 0.03) in the case group that received eradication in all studies, especially in Western populations. There was no significant difference in the incidence of symptoms after eradication between patient and control groups, regardless of category, location of population, or baseline disease. Conclusions: Eradication therapy for H pylori increases the risk of reflux esophagitis, irrespective of past history of esophagitis. In contrast, no effect was seen on reflux-related symptoms.

scholarly journals Risk of Reflux-Related Symptoms and Reflux Esophagitis after Helicobacter pylori Eradication Treatment in the Japanese Population

2021 ◽  
Vol 10 (7) ◽  
pp. 1434
Author(s):  
Mitsushige Sugimoto ◽  
Masaki Murata ◽  
Eri Iwata ◽  
Naoyoshi Nagata ◽  
Takao Itoi ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Reflux Esophagitis ◽  
Odds Ratio ◽  
Japanese Population ◽  
Meta Analysis ◽  
Eradication Therapy ◽  
Helicobacter Pylori Eradication ◽  
Different Populations ◽  
H Pylori ◽  
Japanese Subjects

Backgrounds: A meta-analysis of reports primarily from Western countries showed no association between Helicobacter pylori eradication and reflux esophagitis development. The risk of reflux esophagitis may differ among different populations based on H. pylori virulence factors and acid secretion ability. We evaluated the prevalence rates of reflux esophagitis in H.-pylori-positive Japanese subjects and assessed risk factors for reflux esophagitis after eradication. Methods: Among 148 H.-pylori-positive subjects who underwent H. pylori eradication from August 2015 to December 2019, we evaluated the prevalence of reflux esophagitis on endoscopy at 12 months after eradication success and the severity of reflux-related symptoms by the F-scale questionnaire at 2 months after treatment and 12 months after eradication success. Results: The prevalence of reflux esophagitis in H.-pylori-positive patients at entry was 2.0% (3/148). At 12 months after eradication success, the prevalence was 10.8% (16/148) (p < 0.01). In the F scale, the median total score before treatment was 4 (range: 0–49), which significantly decreased to 2 (range: 0–22) (p < 0.01) at 2 months after treatment and 3 (range: 0–23) (p < 0.01) at 12 months after eradication success. Following multivariate analysis, the pretreatment total F-scale score was a risk factor for the development of reflux esophagitis (odds ratio: 1.069, 95% confidence interval: 1.003–1.139, p < 0.01). Conclusions: In this H.-pylori-positive Japanese population, eradication therapy was associated with reflux esophagitis in around 10% of patients, particularly in those with severe reflux-related symptoms at baseline. Reflux-related symptoms may improve throughout the 12 months after successful eradication therapy, irrespective of the development of reflux esophagitis.

scholarly journals Could gastric histology be a useful marker for making decision on Helicobacter pylori eradication therapy in patients with dyspepsia?

2009 ◽  
Vol 46 (3) ◽  
pp. 209-213 ◽  
Author(s):  
Severino Marcos Borba de Arruda ◽  
Nora Manoukian Forones ◽  
Norma Thomé Jucá ◽  
Kátia Simone Cezário de Barros
Keyword(s):  
Helicobacter Pylori ◽  
Functional Dyspepsia ◽  
Eradication Therapy ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Upper Gastrointestinal Endoscopy ◽  
Serological Tests ◽  
Cross Sectional ◽  
Helicobacter Pylori Eradication ◽  
H Pylori

CONTEXT: It still remains an open debate whether Helicobacter pylori eradication is beneficial or not for the improvement of symptoms in functional dyspepsia. Differences in geographic distribution, the worldwide H. pylori genetic variability and the fact that the outcome of infection is strongly related to the virulence of the infecting strain are factors that might be driving ongoing controversies. OBJECTIVE: To study the correlation between gastric histology and H. pylori serology status in patients with dyspepsia. METHODS: This is a cross-sectional study where 40 consecutive dyspeptic patients (28 women and 12 men, mean age 48.5 years) with endoscopically normal stomachs were selected from the endoscopy unit at a university hospital in Recife, PE, Northeast of Brazil, between March 1998 and July 1999. Patients underwent gastric mucosal biopsy and serological tests (anti-Hp and anti-CagA antibodies). Gastric biopsies were examined using H-E and Giemsa stains and gastritis was classified and graded (mild, moderate or severe) according to "the updated Sydney System - Houston, 1994". RESULTS: Among 40 patients with dyspepsia the gastric histology revealed that about ¼ had moderate (25%) or severe (2.5%) gastritis. This subgroup of patients also had a greater positive frequency of anti-Hp (100% vs 41%; P = 0.0005) and anti-CagA (91% vs 58%; P = 0.09) antibodies when compared with those with normal histology (27.5%) or mild gastritis (45%). CONCLUSION: Since upper gastrointestinal endoscopy is part of the functional dyspepsia investigation and serology for anti-CagA antibody is not available in daily clinical practice, by biopsying gastric mucosa we would only be able to selectively apply H. pylori eradication therapy for those with histology that best correlate with virulent infecting strains (moderate or severe gastritis) - around ¼ of our study patients with dyspepsia.

scholarly journals Effect of Proton Pump Inhibitor Based Triple Therapy with Apple Cider Vinegar on Helicobacter Pylori Eradication

2014 ◽  
Vol 3 (2) ◽  
pp. 90-94
Author(s):  
Shaahin Shahbazi ◽  
Zahra Vahdat Shariatpanahi ◽  
Nourkhoda Sadeghifard
Keyword(s):  
Helicobacter Pylori ◽  
Triple Therapy ◽  
Eradication Therapy ◽  
Urea Breath Test ◽  
Control Group ◽  
Helicobacter Pylori Eradication ◽  
Apple Cider ◽  
Duration Of Therapy ◽  
H Pylori ◽  
And Control

Background: The purpose of this study was to evaluate the effect of apple cider vinegar plus PPI-based triple therapy on eradication of Helicobacter Pylori (H.pylori) infection.Materials and Methods: 116 patients with H. pylori infection were included in this randomized clinical trial. Patients in control group (n=59) received amoxicillin, clarithromycin, and pantaprazole twice daily. Patients in study group (57 patients) received the same regimen plus 30 mL of apple cider vinegar twice daily. The duration of therapy for study and control were 10 and 14 days respectively. Four weeks after the completion of therapy, Urea breath test was performed to assess the success of H.pylori infection eradication.Results: 86% of patients in control group in comparison to 88% in apple cider vinegar group responded to eradication therapy (P=0.41).Conclusion: Addition of apple cider vinegar to proton pomp inhibitor (PPI)-based triple therapy may decrease the duration of H. pylori treatment but it was not statistically significant. Thus, our results showed no efficacy of apple cider vinegar in H. pylory eradication treatment.

scholarly journals The role of acid inhibition in Helicobacter pylori eradication

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 1747 ◽  
Author(s):  
David R. Scott ◽  
George Sachs ◽  
Elizabeth A. Marcus
Keyword(s):  
Helicobacter Pylori ◽  
Urease Activity ◽  
Eradication Therapy ◽  
Acid Inhibition ◽  
Acid Suppression ◽  
Helicobacter Pylori Eradication ◽  
Ulcer Disease ◽  
Chronic Active Gastritis ◽  
H Pylori

Infection of the stomach by the gastric pathogen Helicobacter pylori results in chronic active gastritis and leads to the development of gastric and duodenal ulcer disease and gastric adenocarcinoma. Eradication of H. pylori infection improves or resolves the associated pathology. Current treatments of H. pylori infection rely on acid suppression in combination with at least two antibiotics. The role of acid suppression in eradication therapy has been variously attributed to antibacterial activity of proton pump inhibitors directly or through inhibition of urease activity or increased stability and activity of antibiotics. Here we discuss the effect of acid suppression on enhanced replicative capacity of H. pylori to permit the bactericidal activity of growth-dependent antibiotics. The future of eradication therapy will rely on improvement of acid inhibition along with current antibiotics or the development of novel compounds targeting the organism’s ability to survive in acid.

scholarly journals Efficacy of Helicobacter pylori Eradication Therapy on Platelet Recovery in Pediatric Immune Thrombocytopenic Purpura-Case Series and a Systematic Review

2020 ◽  
Vol 8 (10) ◽  
pp. 1457
Author(s):  
Tamaki Ikuse ◽  
Masanori Toda ◽  
Kosuke Kashiwagi ◽  
Kimiko Maruyama ◽  
Masumi Nagata ◽  
...  
Keyword(s):  
Systematic Review ◽  
Helicobacter Pylori ◽  
Immune Thrombocytopenic Purpura ◽  
Pediatric Patients ◽  
Eradication Therapy ◽  
Platelet Response ◽  
Thrombocytopenic Purpura ◽  
Helicobacter Pylori Eradication ◽  
H Pylori ◽  
Helicobacter Pylori Eradication Therapy

Evidence relating to the efficacy of Helicobacter pylori eradication therapy for chronic immune thrombocytopenic purpura (cITP) in childhood is inadequate. The aim of this retrospective study was to determine the efficacy of H. pylori eradication therapy for platelet response in pediatric patients with cITP in our hospital, and to perform a systematic review of previous reports about pediatric patients with cITP who were positive for H. pylori infection and were treated with H. pylori eradication therapy. Analysis of the data of pediatric patients with cITP in our hospital and a systematic review of digital literature databases of studies in pediatric patients with cITP were performed. Data of 33 pediatric patients with cITP from our hospital records showed that the prevalence of H. pylori infection and the rate of response to platelet therapy were 15% and 33.3%, respectively. Data of 706 pediatric patients from 18 previous reports showed that the prevalence of H. pylori infection and rate of platelet response were 23% and 43.8%, respectively. Eradication therapy for H. pylori infection in pediatric cITP patients can be expected to result in a response equivalent to that in the adult population, with fewer adverse effects than other treatments for cITP.

scholarly journals Decreased Mortality in Coronavirus Disease 2019 Patients Treated With Tocilizumab: A Rapid Systematic Review and Meta-analysis of Observational Studies

2020 ◽  
Author(s):  
Jishnu Malgie ◽  
Jan W Schoones ◽  
Bart G Pijls
Keyword(s):  
Side Effects ◽  
Meta Analysis ◽  
Risk Difference ◽  
World Health ◽  
Cochrane Library ◽  
Control Group ◽  
Number Needed To Treat ◽  
Receptor Antagonists ◽  
Increased Risk ◽  
Health Organization

Abstract Background We systematically reviewed the literature to answer the following research questions: (1) Does interleukin 6 (IL-6) (receptor) antagonist therapy reduce mortality in coronavirus disease 2019 (COVID-19) patients compared to patients not treated with IL-6 (receptor) antagonists; and (2) is there an increased risk of side effects in COVID-19 patients treated with IL-6 (receptor) antagonists compared to patients not treated with IL-6 (receptor) antagonists? Methods We systematically searched PubMed, PMC PubMed Central, Medline, World Health Organization COVID-19 Database, Embase, Web of Science, Cochrane Library, Emcare, and Academic Search Premier (through 30 June 2020). Random effects meta-analysis was used to pool the risk ratios and risk differences of individual studies. Risk of bias was appraised using the Methodological Index for Non-randomized Studies (MINORS) checklist. Results The search strategy retrieved 743 unique titles, of which 10 studies (all on tocilizumab [TCZ]) comprising 1358 patients were included. Nine of 10 studies were considered to be of high quality. Meta-analysis showed that the TCZ group had lower mortality than the control group. The risk ratio was 0.27 (95% confidence interval [CI], .12–.59) and the risk difference was 12% (95% CI, 4.6%–20%) in favor of the TCZ group. With only a few studies available, there were no differences observed regarding side effects. Conclusions Our results showed that mortality was 12% lower for COVID-19 patients treated with TCZ compared with those not treated with TCZ. The number needed to treat was 11, suggesting that for every 11 (severe) COVID-19 patients treated with TCZ, 1 death is prevented. These results require confirmation by randomized controlled trials.

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