Letters

Eradication of Helicobacter pylori infection in non-ulcer dyspepsia

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7230.311/b (Published 29 January 2000) Cite this as: BMJ 2000;320:311

Commentary did not inform or update general medical community

  1. Derek Gillen, lecturer in medicine and gastroenterology,
  2. Kenneth E L McColl, professor of medicine and gastroenterology
  1. University Department of Medicine and Therapeutics, Western Infirmary, Glasgow G11 6NT
  2. University Department of Paediatric Gastroenterology, Royal Free NHS Trust, London NW3 2QG

    EDITOR—Thomson's commentary on the paper by Dominici et al on familial clustering of Helicobacter pylori was presumably intended to inform and update the general medical community.1 In relation to the eradication of H pylori in non—ulcer dyspepsia he states that, “a recent prospective study strongly suggests that there is no basis for this.”2 For many years, however, this topic has been keenly debated, and it continues to be so. It is therefore unfortunate that he does not mention the Medical Research Councils's dyspepsia trial from Glasgow3 or a study from Ireland.4 Both of these studies show a positive benefit of about 10% over placebo for one—off eradication treatment in non—ulcer dyspepsia. This degree of benefit is similar to that of any other chronic treatment such as proton pump inhibitors, previously studied in non-ulcer dyspepsia. Both of these studies were published before the study that Thomson quotes.2 Furthermore, the other previously published trial that he did not mention5 shows a positive trend at a similar level to the other two trials,4 although it does not show a significant benefit at a power of 80% to show a 20% benefit over placebo.

    The omission of these three trials, all published before the one quoted, suggests a lack of balance, a lack of acquaintance with the literature, or overly stringent editorial restrictions. At best, this commentary is therefore worthless in informing and updating the general medical community on the current evidence on managing non—ulcer dyspepsia. At worst, it is misleading.

    References

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    Author's reply

    1. Mike Thomson, consultant in paediatric gastroenterology and nutrition (mthomson{at}rfhsm.ac.uk)
    1. University Department of Medicine and Therapeutics, Western Infirmary, Glasgow G11 6NT
    2. University Department of Paediatric Gastroenterology, Royal Free NHS Trust, London NW3 2QG

      EDITOR—I thank Gillen and McColl for their comments on a commentary that was, as they rightly perceive, editorially constrained by lack of space, reference culling being a feature of this. My commentary was not intended to be a wide ranging Cochrane style review but to inform, as succinctly as possible, the basics of knowledge to date on Helicobacter pylori. In such a contentious subject anyone can cite references to suit his or her position, as Gillen and McColl seem to have done, but because my commentary was constrained by space, preventing all-inclusiveness, I am guilty at most of an inadvertent bias.

      Gillen and McColl cite a trend in the paper by Blum et al that is always interesting but not scientifically persuasive,1 but they do not mention a much more recent paper showing no effect on non-ulcer dyspepsia of eradicating H pylori infection, which has at least one author in common with that of the paper by Blum et al.2 Talley et al show no improvement in symptoms or quality of life or significant association between treatment success and histological improvement in chronic gastritis at one year.2 This is, in addition, a randomised double blind controlled trial reaffirming the results of the study quoted in my commentary by Talley et al reported earlier in 1999.3

      Clearly, this subject will remain a matter of debate. I am sure that a wider remit in future similar commentaries would allow a broader citing of references in all aspects of H pylori, the treatment of non-ulcer dyspepsia being only one of many that are hotly debated.

      References

      1. 1.
      2. 2.
      3. 3.
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