BMJ, doi: 10.1136/bmj.38702.662546.55, (Published 20 January 2006)

RESEARCH

Impact of Helicobacter pylori eradication on dyspepsia, health resource use, and quality of life in the Bristol helicobacter project: randomised controlled trial

J Athene Lane ^1*, Liam J Murray ², Sian Noble ¹, Matthias Egger ³, Ian M Harvey ⁴, Jenny L Donovan ¹, Prakash Nair ⁵, Richard F Harvey ⁶

¹ Department of Social Medicine, University of Bristol, Bristol BS8 2PR
² Department of Epidemiology and Public Health, Queens University of Belfast, Belfast BT9 5EE
³ Institute of Social and Preventative Medicine, University of Bern, 3012 Bern, Switzerland
⁴ School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ
⁵ Peterborough District Hospital, Peterborough Hospitals Trust, Peterborough PE3 6DA
⁶ Frenchay Hospital, North Bristol Healthcare Trust, Bristol BS16 1LE

^* Correspondence to: Athene.lane{at}bristol.ac.uk.

Objective To determine the impact of a community based Helicobacter pylori screening and eradication programme on the incidence of dyspepsia, resource use, and quality of life, including a cost consequences analysis.

Design H pylori screening programme followed by randomised placebo controlled trial of eradication.

Setting Seven general practices in southwest England.

Participants 10 537 unselected people aged 20-59 years were screened for H pylori infection (¹³C urea breath test); 1558 of the 1636 participants who tested positive were randomised to H pylori eradication treatment or placebo, and 1539 (99%) were followed up for two years.

Intervention Ranitidine bismuth citrate 400 mg and clarithromycin 500 mg twice daily for two weeks or placebo.

Main outcome measures Primary care consultation rates for dyspepsia (defined as epigastric pain) two years after randomisation, with secondary outcomes of dyspepsia symptoms, resource use, NHS costs, and quality of life.

Results In the eradication group, 35% fewer participants consulted for dyspepsia over two years compared with the placebo group (55/787 v 78/771; odds ratio 0.65, 95% confidence interval 0.46 to 0.94; P=0.021; number needed to treat 30) and 29% fewer participants had regular symptoms (odds ratio 0.71, 0.56 to 0.90; P=0.05). NHS costs were £84.70 (£74.90 to £93.91) greater per participant in the eradication group over two years, of which £83.40 ($146; 121 euros) was the cost of eradication treatment. No difference in quality of life existed between the two groups.

Conclusions Community screening and eradication of H pylori is feasible in the general population and led to significant reductions in the number of people who consulted for dyspepsia and had symptoms two years after treatment. These benefits have to be balanced against the costs of eradication treatment, so a targeted eradication strategy in dyspeptic patients may be preferable.

---

(Accepted 8 November 2005)
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Dyspepsia and Helicobacter pylori

Rupal Shah
BMJ 2007 334: 41-43. [Extract] [Full Text] [PDF]

H pylori screening and eradication cuts dyspepsia—but at a cost
BMJ 2006 332: 0. [Full Text] [PDF]

Who benefits from Helicobacter pylori eradication?

Brendan C Delaney
BMJ 2006 332: 187-188. [Extract] [Full Text] [PDF]

Is economic evaluation in touch with society's health values?

Joanna Coast
BMJ 2004 329: 1233-1236. [Extract] [Full Text] [PDF]

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

Richard F Harvey, J Athene Lane, Liam J Murray, Ian M Harvey, Jenny L Donovan, and Prakash Nair
BMJ 2004 328: 1417. [Abstract] [Full Text] [PDF]

Eradication of Helicobacter pylori and use of antisecretory drugs: population based cohort study

Annmarie Lassen, Jesper Hallas, and Ove B Schaffalitzky de Muckadell
BMJ 2003 327: 603. [Extract] [Full Text] [PDF]

Treating Helicobacter pylori infection in primary care patients with uninvestigated dyspepsia: the Canadian adult dyspepsia empiric treatmentHelicobacter pylori positive (CADET-Hp) randomised controlled trial

Naoki Chiba, Sander J O Veldhuyzen van Zanten, Paul Sinclair, Ralph A Ferguson, Sergio Escobedo, and Eileen Grace
BMJ 2002 324: 1012. [Abstract] [Full Text] [PDF]

Systematic review and economic evaluation of Helicobacter pylori eradication treatment for non-ulcer dyspepsia

Paul Moayyedi, Shelly Soo, Jonathan Deeks, David Forman, James Mason, Michael Innes, and Brendan Delaney
BMJ 2000 321: 659-664. [Abstract] [Full Text] [PDF]

The epidemiology of stomach cancer: correlating the past with the present

David Forman and Karen J Goodman
BMJ 2000 320: 1682-1683. [Extract] [Full Text] [PDF]

How should cost data in pragmatic randomised trials be analysed?

Simon G Thompson and Julie A Barber
BMJ 2000 320: 1197-1200. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Lee, Y.-C., Liou, J.-M., Wu, C.-Y., Lin, J.-T. (2008). Review: Eradication of Helicobacter pylori to prevent gastroduodenal diseases: Hitting more than one bird with the same stone. Therapeutic Advances in Gastroenterology 1: 111-120 [Abstract]  
• Shah, R. (2007). Dyspepsia and Helicobacter pylori. BMJ 334: 41-43 [Full text]  
• (2006). Does Community H. pylori Screening and Treatment Reduce Dyspepsia Symptoms?. JWatch General 2006: 2-2 [Full text]  
• Delaney, B. C (2006). Who benefits from Helicobacter pylori eradication?. BMJ 332: 187-188 [Full text]  

Rapid Responses:

Read all Rapid Responses

Helicobacter Pylori eradication

DAVID D HOLLAND
bmj.com, 25 Jan 2006 [Full text]

Population screening and treatment for Helicobacter pylori

Alexander C. Ford, et al.
bmj.com, 3 Feb 2006 [Full text]

A marketing ploy in the guise of clinical research?

James Penston
bmj.com, 4 Feb 2006 [Full text]

Squeezing the balloon

Guduru Gopal Rao, et al.
bmj.com, 5 Feb 2006 [Full text]

Screening vs. testing symptomatic patients

Brian S. Alper
bmj.com, 5 Feb 2006 [Full text]

The impact of H pylori eradication on dyspepsia, health resource use and quality of life in the Bristol Helicobacter project: authors reply

J Athene Lane, et al.
bmj.com, 24 Feb 2006 [Full text]

subgroup analysis of asymptomatic patients

Brian S. Alper
bmj.com, 1 Mar 2006 [Full text]

A marketing ploy in the guise of clinical research? –further comments

James Penston
bmj.com, 3 Mar 2006 [Full text]

Online poll

Find out more>>