Clinical Question

How effective is the eradication of Helicobacter pylori for the treatment of functional dyspepsia?

Bottom Line

H. pylori eradication is an effective treatment for cure or improvement of functional dyspepsia symptoms, especially if there is evidence of successful H. pylori eradication. (Level of Evidence = 1a)

Synopsis

The systematic review updated a previous Cochrane review with 10 new trials and 2,896 patients, for a total of 29 trials and 6,781 patients. The authors did a high-quality systematic review to identify randomized trials with at least three months of follow-up, using a random effects meta-analysis. Only six studies were classified as having a low risk of bias, and the most common problems were unclear allocation concealment and unclear complete outcome reporting. Based on 18 studies with 4,564 patients, H. pylori eradication therapy decreased the likelihood of failure to cure functional dyspepsia (relative risk [RR] = 0.91; 95% CI, 0.88 to 0.94; I² = 7%; number needed to treat [NNT] = 14). There was some evidence for publication bias, suggesting that smaller, negative trials were not published. The benefit was consistent regardless of the comparator (i.e., placebo or antisecretory therapy) or study quality. Based on 22 studies with 5,193 patients, H. pylori eradication therapy decreased the likelihood of failure to improve symptoms, without evidence of publication bias but with moderate heterogeneity (RR = 0.84; 95% CI, 0.78 to 0.91; I² = 69%; NNT = 9). Sixteen studies reported whether eradication was successful, and patients with successful eradication were significantly less likely to fail to improve or fail to be cured than those who received the comparator (RR = 0.74; 95% CI, 0.64 to 0.85; I² = 82%; NNT = 6). There was significant heterogeneity, and funnel plot asymmetry suggests possible publication bias.