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Am Fam Physician. 2001;63(5):971

Eradication of Helicobacter pylori infection effectively cures patients with peptic ulcer disease, but the effect of such treatment on patients with nonulcer dyspepsia is less well established. Many studies have been poorly designed and offer conflicting results. Moayyedi and colleagues conducted a systematic review to evaluate the efficacy and cost effectiveness of eradication therapy for H. pylori infection in patients with nonulcer dyspepsia.

Randomized, controlled trials fulfilling eligibility requirements were included in the review. Studies were identified through a search of six electronic databases and the bibliographies of the retrieved studies. Leading international experts, pharmaceutical companies and the editors of selected journals were contacted to identify relevant articles in peer review or in press. Data were abstracted from the studies using standardized protocols from eligible trials. The effect of eradication in each trial was expressed as a relative risk. The number needed to treat was calculated. Economic analyses were generated using a Markov model.

From an initial field of more than 5,000 articles, 12 trials met eligibility and quality criteria and were included in the systematic review. Three of these 12 trials, involving 2,541 patients, evaluated the effect of H. pylori eradication treatment in patients with symptoms of dyspepsia, defining dyspepsia cure as no symptoms or mild symptoms not interfering with daily activities. In these trials, the mean placebo response rate at one year was 28 percent, and the mean H. pylori eradication treatment response rate was 36 percent. Overall, a small but significant benefit was evident at 12 months (relative risk reduction, 9 percent). The number of patients needed to treat with H. pylori eradication to cure one extra person with nonulcer dyspepsia was 15.

Three of the 12 trials presented data on quality of life at 12 months and were included in the meta-analysis. Overall, eradication treatment of H. pylori had no significant effect on quality of life compared with placebo. From the cost-effectiveness analyses, the authors estimate that eradication therapy was approximately $45 more expensive per patient per year than the use of antacids, but the patients benefitted from two to three additional weeks of freedom from symptoms. The decisions about cost-effectiveness of treatment depended primarily on the willingness of the patient to pay for each month free of dyspepsia symptoms and to accept an uncertain outcome. The authors estimate that H. pylori eradication therapy would cost approximately $112 per dyspepsia-free month during the first year after treatment.

The authors conclude that patients with dyspepsia and normal endoscopic results gain a modest benefit from eradication of H. pylori infection and it may be cost effective, but further evidence is needed of the decision makers' willingness to pay for the relief of dyspepsia.

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