BMJ  2003;326:1460 (28 June), doi:10.1136/bmj.326.7404.1460

Letter

Helicobacter pylori in gastro-oesophageal reflux disease needs comparator

The first 150 words of the full text of this article appear below.

EDITOR—The systematic review by Raghunath et al was rigorous and well intentioned.1 However, their conclusion that the prevalence of Helicobacter pylori infection was significantly lower in patients with than without gastro-oesophageal reflux disease may be potentially misleading. The pooled control group in the meta-analysis was heterogeneous and consisted of asymptomatic subjects as well as patients with functional dyspepsia, anaemia, diarrhoea, or chest pain. What would be the clinical relevance of such a comparison?

It would probably have made more sense to pool the studies that used asymptomatic subjects as controls.2–4 The pooled odds ratio would have been 0.57 (95% confidence interval 0.24 to 1.39; random effects model used due to significant heterogeneity). The (cautious) conclusion would have been that the prevalence of H pylori infection in patients with gastrooesophageal reflux disease does not differ significantly from the prevalence in asymptomatic controls.

Meta-analyses of observational studies may produce very . . . [Full text of this article]

Grigoris I Leontiadis, senior clinical fellow in gastroenterology

grleo@yahoo.com

Savvas Kadis, consultant gastroenterologist

Queen Elizabeth Hospital, Gateshead, Tyne and Wear NE9 6SX

Virender K Sharma, senior associate consultant

Division of Gastroenterology, Mayo Clinic, Scottsdale, Arizona, USA

Colin W Howden, professor of medicine

Division of Gastroenterology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA


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