Effect of Helicobacter pylori Treatment on Gastroesophageal Reflux Disease (GERD): Meta-Analysis of Randomized Controlled Trials

Saad, Abdo; Choudhary, Abhishek; Sathyamurthy, Anjana; Hammad, Hazem; Arif, Murtaza; Bechtold, Matthew L.; Ibdah, Jamal A.

doi:10.1016/s0016-5085(11)61603-x

Cited by 20 publications

(22 citation statements)

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“…A recent meta-analysis demonstrated that eradication of H. pylori was related to the higher risk of developing GORD in Asian studies 44. In contrast, no such risk has been reported by Western studies 45. However, two recent large-scale cohort studies in Korea produced inconsistent results 46 47.…”

Section: Discussionmentioning

confidence: 92%

A large randomised controlled intervention trial to prevent gastric cancer by eradication ofHelicobacter pyloriin Linqu County, China: baseline results and factors affecting the eradication

Pan

Lian

Gerhard

et al. 2015

Gut

159

121

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Objective To clarify the full range of benefits and adverse consequences of Helicobacter pylori eradication as a strategy for gastric cancer prevention, the community-based intervention trial was launched in Linqu County, China. Design A total of 184 786 residents aged 25-54 years were enrolled in this trial and received 13 C-urea breath test. H. pylori positive participants were assigned into two groups, either receiving a 10-day quadruple anti-H. pylori treatment or lookalike placebos together with a single dosage of omeprazole and bismuth. Results The prevalence of H. pylori in trial participants was 57.6%. A total of 94 101 subjects completed the treatment. The overall H. pylori eradication rate was 72.9% in the active group. Gender, body mass index, history of stomach disease, baseline delta over baselinevalue of 13 C-urea breath test, missed medication doses, smoking and drinking were independent predictors of eradication failure. The missed doses and high baseline delta over baseline-value were important contributors in men and women (all P trend <0.001). However, a doseresponse relationship between failure rate and smoking or drinking index was found in men (all P trend <0.001), while high body mass index (P trend <0.001) and history of stomach disease were significant predictors in women. The treatment failure rate increased up to 48.8% (OR 2.87, 95% CI 2.24 to 3.68) in men and 39.4% (OR 2.67, 95% CI 1.61 to 4.42) in women with multiple factors combined. Conclusions This large community-based intervention trial to eradicate H. pylori is feasible and acceptable. The findings of this trial lead to a distinct evaluation of factors influencing eradication that should be generally considered for future eradication therapies. Trial registration number ChiCTR-TRC-10000979 in accordance with WHO ICTRP requirements. INTRODUCTIONHelicobacter pylori (H. pylori) is a recognised cause of chronic gastritis and peptic ulcer disease, and may play an important role in the etiology of Significance of this studyWhat is already known on this subject?▸ Gastric cancer is a global public health burden, nearly one million new cases are diagnosed each year worldwide, of which 42% cases occur in China. ▸ Helicobacter pylori infection is the main risk factor for gastric cancer, and it was classified as a class I carcinogen for gastric cancer by International Agency for Research on Cancer in 1994. ▸ The Shandong Intervention Trial launched in Linqu in 1995 yielded a 39% reduction in gastric cancer incidence rate after 15 years follow-up. ▸ Benefits and adverse consequences of strategy for gastric cancer prevention by eradication of H. pylori are still in concern in the community setting.What are the new findings?▸ The large community-based intervention trial to eradicate H. pylori is feasible and acceptable in a high-risk area of gastric cancer in China. It gained an elimination of 72.9% of H. pylori in such community intervention trial without severe side effects among all the subjects during the entire 30-month trial pe...

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Section: Discussionmentioning

confidence: 92%

A large randomised controlled intervention trial to prevent gastric cancer by eradication ofHelicobacter pyloriin Linqu County, China: baseline results and factors affecting the eradication

Pan

Lian

Gerhard

et al. 2015

Gut

159

121

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“…H pylori should be eradicated and searched in GERD patients who require chronic use of proton pump inhibitors (142,178,209) . The triple therapy is still the most used and recommended worldwide and also in Brazil (4,13,29,31,54,68,124,134,166,207) .…”

Section: Statement 27mentioning

confidence: 99%

3rd BRAZILIAN CONSENSUS ON Helicobacter pylori

Coelho

Maguinilk

Zaterka³

et al. 2013

Arq. Gastroenterol.

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Significant progress has been obtained since the Second Brazilian Consensus Conference on Helicobacter pylori Infection held in 2004, in São Paulo, SP, Brazil, and justify a third meeting to establish updated guidelines on the current management of H. pylori infection. The Third Brazilian Consensus Conference on H pylori Infection was organized by the Brazilian Nucleus for the Study of Helicobacter, a Department of the Brazilian Federation of Gastroenterology and took place on April 12-15, 2011, in Bento Gonçalves, RS, Brazil. Thirty-one delegates coming from the five Brazilian regions and one international guest, including gastroenterologists, pathologists, epidemiologists, and pediatricians undertook the meeting. The participants were allocated in one of the five main topics of the meeting: H pylori, functional dyspepsia and diagnosis; H pylori and gastric cancer; H pylori and other associated disorders; H pylori treatment and retreatment; and, epidemiology of H pylori infection in Brazil. The results of each subgroup were submitted to a final consensus voting to all participants. Relevant data were presented, and the quality of evidence, strength of recommendation, and level of consensus were graded. Seventy per cent and more votes were considered as acceptance for the final statement. This article presents the main recommendations and conclusions to guide Brazilian doctors involved in the management of H pylori infection.

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“…In contrast, a meta-analysis of 14 casecontrol and 10 clinical trials by Cremonini et al [58] reported a positive association between anti-H. pylori therapy and the occurrence of both de novo and rebound/ exacerbated GORD. A newly published meta-analysis of 10 RCTs by Saad et al [59] suggested that treatment of H. pylori infection did not seem to increase GORD symptoms or reflux esophagitis; instead, documented eradication of H. pylori infection appeared to significantly improve GORD symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…First, they elided the influence of regions and race and did not carry out subanalysis in relation to geographic and ethnic characteristics. Second, they included very few studies from Asian countries; only one study with a small sample size of 104 patients was included in the meta-analysis by Saad et al [59]. Studies in different geographic regions or populations may result in entirely different outcomes because of different living and eating habits.…”

Section: Discussionmentioning

confidence: 99%