BMJ 1999;319:1040-1044 ( 16 October )

General Practice

Is Helicobacter pylori associated with non-ulcer dyspepsia and will eradication improve symptoms? A meta-analysis

R Liisa Jaakkimainen, Adam Linton fellow in health services research, ^a Eleanor Boyle, doctorate candidate, ^b Fred Tudiver, director. ^c

^a Institute for Clinical Evaluative Sciences, Department of Family and Community Medicine, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada M4N 3M5, ^b Inner City Health Research, St Michael's Hospital, Toronto, Ontario, Canada M5B 1W8, ^c Department of Family Medicine, Center for Evidence-Based Practice, State University of New York Health Science Centre at Syracuse, NY 13210, USA

Correspondence to: R L Jaakkimainen liisa.jaakkimainen{at}ices.on.ca

Objectives: To examine the association between Helicobacter pylori infection and non-ulcer dyspepsia, and to assess the effect of eradicating H pylori on dyspeptic symptoms in patients with non-ulcer dyspepsia.
Design: Systematic review and meta-analysis of (a) observational studies examining the association between Helicobacter pylori infection and non-ulcer dyspepsia (association studies), and (b) therapeutic trials examining the association between eradication of H pylori and dyspeptic symptoms in patients with non-ulcer dyspepsia (eradication trials).
Data sources: Randomised controlled trials and observational studies conducted worldwide and published between January 1983 and March 1999.
Main outcome measures: Summary odds ratios and summary symptom scores.
Results: 23 association studies and 5 eradication trials met the inclusion criteria. In the association studies the summary odds ratio for H pylori infection in patients with non-ulcer dyspepsia was 1.6 (95% confidence interval 1.4 to 1.8). In the eradication trials the summary odds ratio for improvement in dyspeptic symptoms in patients with non-ulcer dyspepsia in whom H pylori was eradicated was 1.9 (1.3 to 2.6).
Conclusions: Some evidence shows an association between H pylori infection and dyspeptic symptoms in patients referred to gastroenterologists. An improvement in dyspeptic symptoms occurred among patients with non-ulcer dyspepsia in whom H pylori was eradicated.

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Rapid Responses:

Read all Rapid Responses

Problems with the summary estimates

Christopher Cates
bmj.com, 18 Oct 1999 [Full text]

Why exclude foreign language publications?

Adam Jacobs
bmj.com, 19 Oct 1999 [Full text]

Helicobacter pylori and non-ulcer dyspepsia

Brian Scott
bmj.com, 19 Oct 1999 [Full text]

Why being a reviewer in the Cochrane Collaboration is a better deal than working outside it!

Monica Fischer
bmj.com, 20 Oct 1999 [Full text]

A potentially misleading meta-analysis

Brendan Delaney
bmj.com, 25 Oct 1999 [Full text]

Re: Problems with the summary estimates

Liisa Jaakkimainen, et al.
bmj.com, 2 Nov 1999 [Full text]

Authors'' responses

Liisa Jaakkimainen, et al.
bmj.com, 2 Nov 1999 [Full text]

H.pylori vs NUD: A mis-trial

Deirdre McNamara
bmj.com, 9 Nov 1999 [Full text]