Moayyedi P, Soo S, Deeks J, Delaney B, Harris A, Innes M, Oakes R, Wilson S, Roalfe A, Bennett C, Forman D
Gastroenterology Unit, City Hospital NHS Trust, Dudley Road, Winson Green, Birmingham, West Midlands, UK, B18 7QH.
Cochrane Database Syst Rev. 2003(1):CD002096. doi: 10.1002/14651858.CD002096.
Helicobacter pylori (H pylori) is the main cause of peptic ulcer disease. The role of H pylori in non-ulcer dyspepsia is less clear.
To determine the effect of H pylori eradication on dyspepsia symptoms and quality of life scores in patients with non-ulcer dyspepsia.
Trials were identified through electronic searches of the Cochrane Controlled Trials Register (CCTR), MEDLINE, EMBASE, CINAHL and SIGLE, using appropriate subject headings and keywords, searching bibliographies of retrieved articles, and through contacts with experts in the fields of dyspepsia and with pharmaceutical companies.
All parallel group randomised controlled trials (RCTs) comparing drugs to eradicate H pylori with placebo or other drugs known not to eradicate H pylori for patients with non-ulcer dyspepsia.
Data were collected on individual and global dyspeptic symptom scores, quality of life measures and adverse effects. Dyspepsia outcomes were dichotomised into minimal/resolved versus same/worse symptoms.
Fifteen randomised controlled trials were included in the systematic review. Thirteen trials compared antisecretory dual or triple therapy with placebo antibiotics +/- antisecretory therapy, and evaluated dyspepsia at 3-12 months. Twelve of these trials gave results as dichotomous outcomes evaluating 2,903 patients and there was no significant heterogeneity between the studies. There was a 9% relative risk reduction in the H pylori eradication group (95% CI = 5% to 14%) compared to placebo. The number needed to treat to cure one case of dyspepsia = 15 (95% CI = 10 to 28). A further two trials compared Bismuth based H pylori eradication with an alternative pharmacological agent. These trials were smaller and had a shorter follow-up but suggested H pylori eradication was more effective than either H2 receptor antagonists or sucralfate in treating non-ulcer dyspepsia.
REVIEWER'S CONCLUSIONS: H pylori eradication therapy has a small but statistically significant effect in H pylori positive non-ulcer dyspepsia. An economic model suggests this modest benefit may still be cost-effective but more research is needed.
幽门螺杆菌（H pylori）是消化性溃疡疾病的主要病因。幽门螺杆菌在非溃疡性消化不良中的作用尚不清楚。
确定根除幽门螺杆菌对非溃疡性消化不良患者消化不良症状及生活质量评分的影响。
通过电子检索Cochrane对照试验注册库（CCTR）、MEDLINE、EMBASE、CINAHL和SIGLE，使用适当的主题词和关键词，检索检索到文章的参考文献，并通过与消化不良领域的专家及制药公司联系来识别试验。
所有平行组随机对照试验（RCTs），比较用于根除幽门螺杆菌的药物与安慰剂或其他已知不能根除幽门螺杆菌药物治疗非溃疡性消化不良患者的疗效。
收集个体和总体消化不良症状评分、生活质量指标及不良反应的数据。消化不良结局分为最小化/缓解与相同/恶化症状。
系统评价纳入了15项随机对照试验。13项试验比较了抗分泌双联或三联疗法与安慰剂抗生素+/-抗分泌疗法，并在3 - 12个月时评估消化不良情况。其中12项试验给出了二分法结局结果，评估了2903例患者，各研究间无显著异质性。与安慰剂相比，幽门螺杆菌根除组相对风险降低9%（95%CI = 5%至14%）。治愈一例消化不良所需治疗人数 = 15（95%CI = 10至28）。另外两项试验比较了基于铋剂的幽门螺杆菌根除疗法与另一种药物。这些试验规模较小且随访时间较短，但提示幽门螺杆菌根除疗法在治疗非溃疡性消化不良方面比H2受体拮抗剂或硫糖铝更有效。
根除幽门螺杆菌疗法对幽门螺杆菌阳性的非溃疡性消化不良有微小但具有统计学意义的效果。一个经济模型表明这种适度的益处可能仍具有成本效益，但还需要更多研究。
