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

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.38702.662546.55 (Published 26 January 2006) Cite this as: BMJ 2006;332:199
  1. J Athene Lane, research fellow in health services research (Athene.lane{at}bristol.ac.uk)1,
  2. Liam J Murray, senior lecturer in epidemiology2,
  3. Sian Noble, research fellow in health economics1,
  4. Matthias Egger, professor of epidemiology and public health3,
  5. Ian M Harvey, professor of epidemiology and public health4,
  6. Jenny L Donovan, rofessor of social medicine1,
  7. Prakash Nair, consultant gastroenterologist5,
  8. Richard F Harvey, consultant gastroenterologis6
  1. 1 Department of Social Medicine, University of Bristol, Bristol BS8 2PR
  2. 2 Department of Epidemiology and Public Health, Queens University of Belfast, Belfast BT9 5EE
  3. 3 nstitute of Social and Preventative Medicine, University of Bern, 3012 Bern, Switzerland
  4. 4 School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ
  5. 5 Peterborough District Hospital, Peterborough Hospitals Trust, Peterborough PE3 6DA
  6. 6 Frenchay Hospital, North Bristol Healthcare Trust, Bristol BS16 1LE
  1. Correspondence to: J A Lane
  • Accepted 8 November 2005

Abstract

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) 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.

Footnotes

  • Contributors JAL ran the project from day to day and did most of the analyses for the paper with advice from ME. LJM, IMH, JLD, and RFH initiated, planned, and obtained funding for the project. PN helped to set up the project. SN did the economic analysis and was responsible for this aspect of the paper. JAL wrote the initial draft of the paper, and all authors contributed to the final version. JAL is the guarantor.

  • Funding This study was jointly funded by the South and West NHS Research and Development Directorate and GlaxoSmithKline. The department of social medicine of the University of Bristol is the lead centre of the Medical Research Council Health Services Research Collaboration. The randomisation sequence was generated by one of the funders (GlaxoSmithKline), but the sponsors had no further role in the study design, data collection, analyses, or writing up of reports and publications.

  • Competing interests JAL and RFH were funded by GlaxoSmithKline to attend the AGA meeting in 2000.

  • Ethical approval The local research ethics committee approved the study.

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