Helicobacter pylori eradication therapy for functional dyspepsia: Systematic review and meta-analysis

Abstract

Aim: To evaluate whether Helicobacter pylori (H. pylori) eradication therapy benefits patients with functional dyspepsia (FD).

Methods: Randomized controlled trials (RCTs) investigating the efficacy and safety of H. pylori eradication therapy for patients with functional dyspepsia published in English (up to May 2015) were identified by searching PubMed, EMBASE, and The Cochrane Library. Pooled estimates were measured using the fixed or random effect model. Overall effect was expressed as a pooled risk ratio (RR) or a standard mean difference (SMD). All data were analyzed with Review Manager 5.3 and Stata 12.0.

Results: This systematic review included 25 RCTs with a total of 5555 patients with FD. Twenty-three of these studies were used to evaluate the benefits of H. pylori eradication therapy for symptom improvement; the pooled RR was 1.23 (95%CI: 1.12-1.36, P < 0.0001). H. pylori eradication therapy demonstrated symptom improvement during long-term follow-up at ≥ 1 year (RR = 1.24; 95%CI: 1.12-1.37, P < 0.0001) but not during short-term follow-up at < 1 year (RR = 1.26; 95%CI: 0.83-1.92, P = 0.27). Seven studies showed no benefit of H. pylori eradication therapy on quality of life with an SMD of -0.01 (95%CI: -0.11 to 0.08, P = 0.80). Six studies demonstrated that H. pylori eradication therapy reduced the development of peptic ulcer disease compared to no eradication therapy (RR = 0.35; 95%CI: 0.18-0.68, P = 0.002). Eight studies showed that H. pylori eradication therapy increased the likelihood of treatment-related side effects compared to no eradication therapy (RR = 2.02; 95%CI: 1.12-3.65, P = 0.02). Ten studies demonstrated that patients who received H. pylori eradication therapy were more likely to obtain histologic resolution of chronic gastritis compared to those who did not receive eradication therapy (RR = 7.13; 95%CI: 3.68-13.81, P < 0.00001).

Conclusion: The decision to eradicate H. pylori in patients with functional dyspepsia requires individual assessment.

Keywords: Functional dyspepsia; Helicobacter pylori eradication; Meta-analysis; Peptic ulceration; Quality of life; Symptom improvement.

Figure 1

Study flow diagram.

Figure 2

Risk of bias graph. The Cochrane collaboration’s tool was used to evaluate risk of bias.

Figure 3

Funnel plot of included studies for potential publication bias. The funnel plot was not absolutely symmetrical.

Figure 4

Forest plot of the effects comparing Helicobacter pylori eradication therapy vs control on symptom relief. Twenty-three studies were included. The random effect model (Mantel-Haenszel method) was applied.

Figure 5

Sensitivity analysis of the effects comparing Helicobacter pylori eradication therapy vs control on symptom relief.

Figure 6

Forest plot of the effects comparing Helicobacter pylori eradication therapy vs control on quality of life. Seven studies were included. The fixed effect model (Inverse Variance method) was applied.

Figure 7

Forest plot of the effects comparing Helicobacter pylori eradication therapy vs control on long-term peptic ulceration. Six studies were included. The fixed effect (Inverse Variance method) model was applied.

Figure 8

Forest plot of the effects comparing Helicobacter pylori eradication therapy vs control on adverse events. Eight studies were included. The random effect model (Mantel-Haenszel method) was applied.

Figure 9

Sensitivity analysis of the effects comparing Helicobacter pylori eradication therapy vs control on adverse events.

Figure 10

Forest plot of the effects comparing Helicobacter pylori eradication therapy vs control on histologic resolution of chronic gastritis. Six studies were included. The random effect model (Mantel-Haenszel method) was applied.