BMJ 2003;326:737 ( 5 April )

Papers

Prevalence of Helicobacter pylori in patients with gastro-oesophageal reflux disease: systematic review

Anan Raghunath, honorary research fellow, ^a A Pali S Hungin, professor of primary care and general practice, ^a David Wooff, director, ^b Susan Childs, research associate. ^c

^a Centre for Integrated Health Care Research, Wolfson Research Institute, University of Durham, Stockton on Tees TS17 6BH, ^b Department of Mathematical Sciences, Statistics and Mathematics Consultancy Unit, University of Durham, Science Laboratories, Durham DH1 3LE, ^c Information Management Research Institute, School of Information Studies, University of Northumbria, Newcastle upon Tyne NE1 8ST

Correspondence to: A Raghunath raghu{at}nath.freeserve.co.uk

Objectives: To ascertain the prevalence of Helicobacter pylori in patients with gastro-oesophageal reflux disease and its association with the disease.
Design: Systematic review of studies reporting the prevalence of H pylori in patients with and without gastro-oesophageal reflux disease.
Data sources: Four electronic databases, searched to November 2001, experts, pharmaceutical companies, and journals.
Main outcome measure: Odds ratio for prevalence of H pylori in patients with gastro-oesophageal reflux disease.
Results: 20 studies were included. The pooled estimate of the odds ratio for prevalence of H pylori was 0.60 (95% confidence interval 0.47 to 0.78), indicating a lower prevalence in patients with gastro-oesophageal reflux disease. Substantial heterogeneity was observed between studies. Location seemed to be an important factor, with a much lower prevalence of H pylori in patients with gastro-oesophageal reflux disease in studies from the Far East, despite a higher overall prevalence of infection than western Europe and North America. Year of study was not a source of heterogeneity.
Conclusion: The prevalence of H pylori infection was significantly lower in patients with than without gastro-oesophageal reflux, with geographical location being a strong contributor to the heterogeneity between studies. Patients from the Far East with reflux disease had a lower prevalence of H pylori infection than patients from western Europe and North America, despite a higher prevalence in the general population.

What is already known on this topic The relation between H pylori infection and gastro-oesophageal reflux disease is controversial Studies on the prevalence of H pylori in patients with gastro-oesophageal reflux disease have given conflicting results Recent guidelines recommend eradication of H pylori in patients requiring long term proton pump inhibitors, essentially for reflux disease What this study adds Despite heterogeneity between studies, the prevalence of H pylori was significantly lower in patients with than without gastro-oesophageal reflux disease Further well designed studies are required to establish the clinical relevance of the findings, particularly in eradication therapy

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© 2003 BMJ Publishing Group Ltd
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