Peptic ulcer: H. pylori eradication improves healing.

Clinical bottom line (level 1a)

  1. Patients with a gastric ulcer who have had successful H. pylori eradication treatment, are more likely to have healing of the ulcer than those with unsuccessful treatment (NNT = 8 at unknown) .
  2. Patients with a duodenal ulcer who have successful H. pylori treatment, are more likely to have ulcer healing (NNT = 10 at unknown) .
  3. Patients with a peptic ulcer are more likely to have ulcer healing (NNT = 13 at unknown) .
Treiber and Lambert: American Journal of Gastroenterology 1998; 93: 1080-1084
Expires October 2002

The study

Systematic review of of
  • Patients: peptic ulcer
  • Intervention: successful H. pylori treatment compared with unsuccessful H. pylori treatment
  • Outcome: ulcer healing


Articles found in ? using MEDLINE, Jan 1988 to Feb 1997 (search terms: Helicobacter pylori, eradication and ulcer healing ) and Manual searching using Am J Gastroenterol, Gut, Gastroenterology, Scand J Gastroenterol, Eur J Gastroenterol Hepatol, J Dig Dis Sc, Z Gastroenterol and Aliment Pharmacol Ther. All abstracts from major meetings during 1995-1996 that were published in Gastroenterology, as well as those from the workshop on gastroduodenal pathology and Helicobacter pylori (held in Edinburgh) were reviewed

Selection criteria: Clear list of number of patients enrolled and the manner in which they were treated, H. pylori eradication defined as either a negative C13/14 urea breath test or negative histology and negative urease test = 4 week after the end of therapy, and healing rate and time of healing of ulcer was stated.
Appraisal criteria: Not given
Articles excluded if: less than 10 patients, paediatric studies and studies with a pretreatment of acid suppression >1 week

60 studies with 4329 patients were identified.

The evidence

Outcome Time to outcome CER OR
(95% CI)		 NNT
(95% CI)
healing of gastric ulcer unknown 222/288
(77.1%)		 2.70
(1.30 to 5.40) 		8
(6 to 23)
healing of duodenal ulcer unknown 2747/3139
(87.5%)		 5.10
(4.00 to 6.50) 		10
(10 to 11)
healing of peptic ulcer unknown 817/902
(90.6%)		 6.60
(4.10 to 10.6) 		13
(12 to 14)

Comments

  1. There is no data about the possible heterogeneity of the trials

Citation

  1. Treiber G, and Lambert JR: The impact of Helicobacter pylori eradication on peptic ulcer healing. American Journal of Gastroenterology 1998; 93: 1080-1084
Contributor: Clare Wotton and Musab Hayatli, October 1999
Reviewer: Martin Dawes and Horand Meier

Clinical Question.
    Patient peptic ulcer
    Intervention or Exposure successful H. pylori therapy
    Comparison unsuccessful H. pylori therapy
    Outcome ulcer healing