Laine L, Schoenfeld P, Fennerty M B
Gastrointestinal Division, Department of Medicine, University of Southern California School of Medicine, 2025 Zonal Avenue, Los Angeles, CA 90033, USA.
Ann Intern Med. 2001 Mar 6;134(5):361-9. doi: 10.7326/0003-4819-134-5-200103060-00008.
To assess the effect of eradication therapy for Helicobacter pylori on symptoms of nonulcer dyspepsia.
Duplicate searches of bibliographic databases, reviews of proceedings of annual gastroenterology and H. pylori meetings from 1995 to 1999, reviews of reference lists, and contact with primary investigators and pharmaceutical manufacturers.
Included studies 1) examined patients with nonulcer dyspepsia and H. pylori infection; 2) used combination therapy for H. pylori and a control therapy without efficacy against H. pylori; 3) were randomized, controlled trials; 4) lasted for at least 1 month after the end of therapy; and 5) assessed symptoms of nonulcer dyspepsia. Ten studies were included.
Independent, duplicate data extraction of the methodologic quality, population, intervention, study design, duration, and outcome of the trials.
The odds ratio (OR) for treatment success in nonulcer dyspepsia with H. pylori eradication therapy compared with control therapy was 1.29 (95% CI, 0.89 to 1.89; P = 0.18). However, significant heterogeneity (P = 0.04) calls the validity of aggregating the data into question. Heterogeneity resolved with the exclusion of one study (OR, 1.07 [CI, 0.83 to 1.37]; P > 0.2). For predefined analysis of trials that used a specifically stated definition of dyspepsia (that is, upper abdominal pain or discomfort), the OR was 1.04 (CI, 0.80 to 1.35) without heterogeneity. For treatment that resulted in cure rather than persistent infection, the OR was 1.17 (CI, 0.87 to 1.59) without heterogeneity.
This meta-analysis provides little support for the use of H. pylori eradication therapy in patients with nonulcer dyspepsia.
评估幽门螺杆菌根除治疗对非溃疡性消化不良症状的影响。
对书目数据库进行重复检索，查阅1995年至1999年年度胃肠病学和幽门螺杆菌会议的会议记录，查阅参考文献列表，并与主要研究者和制药商联系。
纳入的研究1）研究了非溃疡性消化不良和幽门螺杆菌感染患者；2）使用幽门螺杆菌联合疗法和对幽门螺杆菌无效的对照疗法；3）为随机对照试验；4）治疗结束后持续至少1个月；5）评估非溃疡性消化不良症状。共纳入10项研究。
对试验的方法学质量、人群、干预措施、研究设计、持续时间和结果进行独立、重复的数据提取。
与对照疗法相比，幽门螺杆菌根除治疗在非溃疡性消化不良中治疗成功的优势比（OR）为1.29（95%可信区间，0.89至1.89；P = 0.18）。然而，显著的异质性（P = 0.04）使汇总数据的有效性受到质疑。排除一项研究后异质性得到解决（OR，1.07 [可信区间，0.83至1.37]；P > 0.2）。对于使用特定定义的消化不良（即上腹部疼痛或不适）进行预定义分析的试验，OR为1.04（可信区间，0.80至1.35），无异质性。对于导致治愈而非持续感染的治疗，OR为1.17（可信区间，0.87至1.59），无异质性。
这项荟萃分析几乎不支持在非溃疡性消化不良患者中使用幽门螺杆菌根除治疗。
