Hansen Jane M, Wildner-Christensen Mette, Hallas Jesper, Schaffalitzky de Muckadell Ove B
Department of Medical Gastroenterology S, Odense University Hospital, Odense, Denmark.
Am J Gastroenterol. 2008 May;103(5):1106-13. doi: 10.1111/j.1572-0241.2007.01770.x. Epub 2008 Apr 28.
Helicobacter pylori (H. pylori) screening and eradication may reduce the incidence of gastric cancer, AND AIMS: peptic ulcer, and ulcer complications, and it may reduce symptoms in a small proportion of individuals with functional dyspepsia. This study aimed to assess the effect of community H. pylori screening and treatment on the prevalence of dyspepsia, and as secondary outcomes, the effect on dyspepsia-related health-care consumption and quality of life over 5 yr.
In 1998-1999, individuals aged 40-65 yr were randomized to H. pylori screening and treatment or to the control group. Five years later, the participants were sent a questionnaire to assess the prevalence of dyspepsia and quality of life. In addition, we obtained information from registers on the use of endoscopies and prescription medication. An economic evaluation was done alongside the randomized trial.
Of 12,530 participants attending the study at baseline, 11,065 (88%) were traced and contacted at the 5-yr follow-up. The response rate was 94%. At baseline, 17.5% in the screened group were H. pylori-positive. The absolute reduction in dyspepsia during the first year was 4% in the screened group, whereas no change was observed in the unscreened group; this rate remained constant during the next 4 yr. Quality of life did not change. A small effect was found for dyspepsia-related consultations and sick leave days, but not on the prescription rate of ulcer drugs. A 33% lower ulcer incidence (107 ulcers vs 148 ulcers) was seen in the screened group compared to the unscreened group.
A population H. pylori screening and treatment program in an H. pylori low-prevalence area had only a modest, but insignificant, effect on the rate of dyspepsia, and a modest, significant effect on the consultation rate and sick leave days for dyspepsia, but resulted in a decreased ulcer incidence. The intervention resulted in an increased cost due to H. pylori screening and treatment.
幽门螺杆菌（H. pylori）筛查与根除可降低胃癌、消化性溃疡及溃疡并发症的发病率，且可能减轻一小部分功能性消化不良患者的症状。本研究旨在评估社区幽门螺杆菌筛查与治疗对消化不良患病率的影响，作为次要结果，评估其对5年内与消化不良相关的医疗保健消费及生活质量的影响。
1998 - 1999年，将40 - 65岁的个体随机分为幽门螺杆菌筛查与治疗组或对照组。5年后，向参与者发送问卷以评估消化不良患病率及生活质量。此外，我们从内镜检查和处方药使用登记处获取信息。在随机试验的同时进行了经济评估。
在基线时参加研究的12,530名参与者中，11,065名（88%）在5年随访时被追踪并联系。应答率为94%。基线时，筛查组中17.5%的人幽门螺杆菌呈阳性。筛查组第一年消化不良的绝对降低率为4%，而未筛查组未观察到变化；在接下来的4年中该率保持不变。生活质量未改变。在与消化不良相关的咨询和病假天数方面发现了较小的影响，但对溃疡药物的处方率没有影响。与未筛查组相比，筛查组的溃疡发病率降低了33%（107例溃疡对148例溃疡）。
在幽门螺杆菌低流行地区开展的人群幽门螺杆菌筛查与治疗项目对消化不良发生率仅有适度但不显著的影响，对消化不良的咨询率和病假天数有适度且显著的影响，但导致溃疡发病率降低。该干预因幽门螺杆菌筛查与治疗导致成本增加。
