The management of Helicobacter pylori infection in primary care: a systematic review of the literature

Abstract

Childs SM, Roberts AP, Meineche-Schmidt V, de Wit NJ and Rubin GP. The management of Helicobacter pylori infection in primary care: a systematic review of the literature. Family Practice 2000; 17: S6-S11. Objective. The aim of the present study was to provide evidence from the literature to inform the production of guidelines by the European Society for Primary Care Gastroenterology (ESPCG) for the management of Helicobacter pylori infection in primary care. Methods. A systematic review was conducted, searching MEDLINE, EMBASE and the Cochrane Library. The systematic review was designed to answer a number of questions: the role of H.pylori in the aetiology of peptic ulcer disease (PUD), gastric cancer (GC), non-ulcer dyspepsia (NUD) and oesophagitis; non-invasive testing for H.pylori and post-treatment testing; eradication therapy; and cost issues. Selection of records concentrated on the highest quality studies, i.e. systematic reviews, meta-analyses and cost analyses. Results.Helicobacter pylori infection is a causal factor in PUD and GC but not in NUD or oesophagitis. Serological tests and urea breath tests (UBTs) can be used for the detection of H.pylori, but UBT is the preferred choice for post-treatment testing. Proton pump inhibitor (PPI)-based triple regimens are the preferred eradication therapy. Eradication therapy is more costeffective than long-term maintenance therapy.Conclusions. Strong evidence is available for answering questions on the aetiology of stomach ulcers and GU, eradication therapies and cost issues. Weaker evidence is available for answering the questions on the aetiology of NUD and non-invasive testing. No evidence is available for answering the question on the role of H.pylori in the aetiology of oesophagitis.

Assessing heterogeneity in meta‐analyses of Helicobacter pylori infection‐related clinical studies: a critical appraisal

“…Of 84 potentially relevant citations, 47 studies were identified as systematic reviews from their abstracts 2,3,6,8–51 . However, subsequent scrutiny of the full articles excluded eight studies that did not meet the criteria for meta‐analysis either because they did not show statistical synthesis of results from the primary studies 13,16,41,47–51 or, as in one study, duplicate publication 35 . Therefore, the current critical appraisal included 38 studies 2,3,6,8–12,14,15,17–34,36–40,42–46 …”

“…Helicobacter pylori infection is highly prevalent, occurring in approximately 50% of the world's adult population, 5 and is associated with a number of upper gastrointestinal diseases 6–8 . In the past 16 years, a large number of epidemiological studies and clinical trials dealing with this infection have been published and subsequently meta‐analyzed to produce summary estimates of risk in the causal relationship between infection and disease or efficacy of different treatment strategies 2,3,6,8–51 . The aim of the current critique is to review the methodological strengths and weaknesses of these meta‐analyses, particularly with respect to the assessment and handling of heterogeneity.…”