Meta-Analysis
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2016; 22(12): 3486-3495
Published online Mar 28, 2016. doi: 10.3748/wjg.v22.i12.3486
Helicobacter pylori eradication therapy for functional dyspepsia: Systematic review and meta-analysis
Li-Jun Du, Bin-Rui Chen, John J Kim, Sarah Kim, Jin-Hua Shen, Ning Dai
Li-Jun Du, Bin-Rui Chen, John J Kim, Sarah Kim, Jin-Hua Shen, Ning Dai, Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310020, Zhejiang Province, China
John J Kim, Division of Gastroenterology, Loma Linda University, Loma Linda, CA 92354, United States
Author contributions: Du LJ and Dai N designed the research; Du LJ and Chen BR performed the research; Du LJ and Shen JH analyzed the data; Du LJ and Kim JJ wrote the paper; Kim JJ, Kim S and Dai N provided critical feedback and revised the manuscript.
Conflict-of-interest statement: The authors have no conflict-of-interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ning Dai, MD, Professor, Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University, No. 3 East Qingchun Road, Hangzhou 310020, Zhejiang Province, China. ndaicn@yahoo.com
Telephone: +86-571-86006144 Fax: +86-571-86044817
Received: November 30, 2015
Peer-review started: December 1, 2015
First decision: December 21, 2015
Revised: January 19, 2016
Accepted: January 30, 2016
Article in press: January 30, 2016
Published online: March 28, 2016
Processing time: 113 Days and 19.6 Hours
Abstract

AIM: To evaluate whether Helicobacter pylori (H. pylori) eradication therapy benefits patients with functional dyspepsia (FD).

METHODS: Randomized controlled trials (RCTs) investigating the efficacy and safety of H. pylori eradication therapy for patients with functional dyspepsia published in English (up to May 2015) were identified by searching PubMed, EMBASE, and The Cochrane Library. Pooled estimates were measured using the fixed or random effect model. Overall effect was expressed as a pooled risk ratio (RR) or a standard mean difference (SMD). All data were analyzed with Review Manager 5.3 and Stata 12.0.

RESULTS: This systematic review included 25 RCTs with a total of 5555 patients with FD. Twenty-three of these studies were used to evaluate the benefits of H. pylori eradication therapy for symptom improvement; the pooled RR was 1.23 (95%CI: 1.12-1.36, P < 0.0001). H. pylori eradication therapy demonstrated symptom improvement during long-term follow-up at ≥ 1 year (RR = 1.24; 95%CI: 1.12-1.37, P < 0.0001) but not during short-term follow-up at < 1 year (RR = 1.26; 95%CI: 0.83-1.92, P = 0.27). Seven studies showed no benefit of H. pylori eradication therapy on quality of life with an SMD of -0.01 (95%CI: -0.11 to 0.08, P = 0.80). Six studies demonstrated that H. pylori eradication therapy reduced the development of peptic ulcer disease compared to no eradication therapy (RR = 0.35; 95%CI: 0.18-0.68, P = 0.002). Eight studies showed that H. pylori eradication therapy increased the likelihood of treatment-related side effects compared to no eradication therapy (RR = 2.02; 95%CI: 1.12-3.65, P = 0.02). Ten studies demonstrated that patients who received H. pylori eradication therapy were more likely to obtain histologic resolution of chronic gastritis compared to those who did not receive eradication therapy (RR = 7.13; 95%CI: 3.68-13.81, P < 0.00001).

CONCLUSION: The decision to eradicate H. pylori in patients with functional dyspepsia requires individual assessment.

Keywords: Functional dyspepsia; Helicobacter pylori eradication; Symptom improvement; Quality of life; Peptic ulceration; Meta-analysis

Core tip: The decision to eradicate Helicobacter pylori (H. pylori) in patients with functional dyspepsia requires individual assessment. This meta-analysis suggests that H. pylori eradication therapy is beneficial for symptom relief, reduces the development of peptic ulceration, and leads to histologic resolution of chronic gastritis but does not improve the quality of life and may even result in adverse events. Otherwise, other validated treatment such as acid suppression, prokinetics, and psychiatric treatment should also be considered.