Meta-Analysis for the Treatment of Helicobacter Pylori

Abstract

Purpose: To assess whether Helicobacter pylori (H. pylori) eradication therapy benefits patients with functional dyspepsia (FD). Methods: Randomized controlled trials (RCTs) examining the efficacy and safety of H. pylori eradication therapy for patients with functional dyspepsia published in English (till November 2016) were recognized by searching PubMed, EMBASE, and The Cochrane Library. Pooled estimates were measured using the fixed or random effect model. Overall effect was expressed as a pooled risk ratio (RR) or a standard mean difference (SMD). All data were analyzed with Review Manager 5.3 and Stata 12.0. Results: This analysis involved 15 RCTs with a total of 3567 patients with FD. These studies were used to assess the benefits of H. pylori eradication therapy for symptom improvement; the pooled RR was 1.26 (95%CI: 1.10-1.40, P < 0.0001). H. pylori eradication therapy demonstrated symptom improvement during long-term follow-up at ≥ 1 year (RR = 1.27; 95%CI: 1.13-1.41, P < 0.0001) but not during short-term follow-up at < 1 year (RR = 1.26; 95%CI: 0.83-1.92, P = 0.27). Four studies showed no benefit of H. pylori eradication therapy on quality of life with an SMD of -0.01 (95%CI: -0.09 to 0.07, P = 0.74). Four studies demonstrated that H. pylori eradication therapy reduced the development of peptic ulcer disease compared to no eradication therapy (RR = 0.34; 95%CI: 0.17-0.67, P = 0.002). Three studies showed that H. pylori eradication therapy increased the likelihood of treatment-related side effects compared to no eradication therapy (RR = 1.87; 95%CI: 1.08-3.47, P = 0.02). Ten studies demonstrated that patients who received H. pylori eradication therapy were more likely to obtain histologic resolution of chronic gastritis compared to those who did not receive eradication therapy (RR = 7.05; 95%CI: 3.59-13.74, P < 0.00001). Conclusion: The decision to eradicate H. pylori in patients with functional dyspepsia requires individual assessment.