Randomised controlled trial of effects of Helicobacter pylori infection and its eradication on heartburn and gastro-oesophageal reflux: Bristol helicobacter project

doi:10.1136/bmj.38082.626725.EE

BMJ 2004;328:1417 (12 June), doi:10.1136/bmj.38082.626725.EE (published 4 May 2004)

Primary care

Randomised controlled trial of effects of Helicobacter pylori infection and its eradication on heartburn and gastro-oesophageal reflux: Bristol helicobacter project

Richard F Harvey, consultant gastroenterologist¹, J Athene Lane, research fellow², Liam J Murray, senior lecturer³, Ian M Harvey, professor of epidemiology and public health⁴, Jenny L Donovan, professor², Prakash Nair, consultant gastroenterologist⁵

¹ Frenchay Hospital, North Bristol NHS Trust, Bristol BS16 1LE, ² Department of Social Medicine, University of Bristol, Bristol BS8 2PR, ³ Department of Epidemiology and Public Health, The Queen's University of Belfast, Belfast BT9 5EE, ⁴ School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, ⁵ Peterborough General Hospital, Peterborough

Correspondence to: R F Harvey richard.harvey1{at}virgin.net

Objectives To investigate the effects of Helicobacter pyloriinfection and its eradication on heartburn and gastro-oesophagealreflux.

Design Cross sectional study, followed by a randomised placebocontrolled trial.

Setting Seven general practices in Bristol, England.

Participants 10 537 people, aged 20-59 years, with and withoutH pylori infection (determined by the ¹³C-urea breath test).

Main outcome measures Prevalence of heartburn and gastro-oesophagealacid reflux at baseline and two years after treatment to eradicateH pylori infection.

Results At baseline, H pylori infection was associated withincreased prevalence of heartburn (odds ratio 1.14, 95% confidenceinterval 1.05 to 1.23) but not reflux (1.05, 0.97 to 1.14).In participants with H pylori infection, active treatment hadno effect on the overall prevalence of heartburn (0.99, 0.88to 1.12) or reflux (1.04, 0.91 to 1.19) and did not improvepre-existing symptoms of heartburn or reflux.

Conclusions H pylori infection is associated with a slightlyincreased prevalence of heartburn but not reflux. Treatmentto eradicate H pylori has no net benefit in patients with heartburnor gastro-oesophageal reflux.

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