Meta-analysis: role of Helicobacter pylori eradication in the prevention of peptic ulcer in NSAID users.

Abstract

AIM:

To evaluate whether eradication of Helicobacter pylori prevents peptic ulcer in non-steroidal anti-inflammatory drug users by means of a meta-analysis.

MATERIAL AND METHODS:

A systematic search was performed in MEDLINE, EMBASE, the Cochrane Controlled Trials Register and the AGA congress. Randomized trials comparing H. pylori eradication vs. non-eradication or eradication vs. a proton pump inhibitor in patients receiving a non-steroidal anti-inflammatory drug were selected.

RESULTS:

Five studies and 939 patients were included in the analysis; 34 of 459 (7.4%) patients developed a peptic ulcer in the eradicated group vs. 64 of 480 (13.3%) in the control group. The odds ratio was 0.43 (95% confidence interval: 0.20-0.93). Sub-analyses showed a significant reduction of risk for non-steroidal anti-inflammatory drug-naive (odds ratio = 0.26; 95% confidence interval: 0.14-0.49) but not for previously treated patients (odds ratio = 0.95, 95% confidence interval: 0.53-1.72). Two studies with a total of 385 patients compared eradication vs. a proton pump inhibitor; five of 196 (2.6%) developed a peptic ulcer in the eradicated group vs. zero of 189 (0%) in the proton pump inhibitor group (odds ratio = 7.43; 95% confidence interval: 1.27-43.6).

CONCLUSION:

Helicobacter pylori eradication reduces the incidence of peptic ulcer in the overall population receiving non-steroidal anti-inflammatory drugs. It appears to be especially effective when performed in non-steroidal anti-inflammatory drug-naïve patients. Nonetheless, eradication seems less effective than treatment with a maintenance proton pump inhibitor for preventing non-steroidal anti-inflammatory drug-associated ulcers.

• Authors: M Vergara, M Catalán, J P Gisbert, X Calvet
• Journal: Alimentary pharmacology & therapeutics (Aliment Pharmacol Ther) Vol. 21 Issue 12 Pg. 1411-8 (Jun 15 2005) ISSN: 0269-2813 [Print] England
• PMID: 15948807 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Anti-Bacterial Agents
• Anti-Inflammatory Agents, Non-Steroidal
• Anti-Ulcer Agents
• Proton Pump Inhibitors
• Amoxicillin
• Omeprazole

Topics

• Amoxicillin (therapeutic use)
• Anti-Bacterial Agents (therapeutic use)
• Anti-Inflammatory Agents, Non-Steroidal (therapeutic use)
• Anti-Ulcer Agents (therapeutic use)
• Clinical Trials as Topic
• Drug Therapy, Combination
• Helicobacter Infections (prevention & control)
• Helicobacter pylori
• Humans
• Odds Ratio
• Omeprazole (therapeutic use)
• Peptic Ulcer (microbiology, prevention & control)
• Proton Pump Inhibitors