Antibiotics for people with peptic ulcers caused by Helicobacter pylori infection

Peptic ulcers are caused by acidic stomach juices damaging the lining of the stomach (gastric ulcer) or upper small intestine (duodenal ulcer). This causes pain, indigestion and sometimes, bleeding. Ulcers can return after being healed, especially if the person is infected with Helicobacter pylori (a lifelong infection unless treated). Helicobacter pylori (or H. pylori) causes most peptic ulcers. The review of trials found that antibiotics for H. pylori have a small benefit in initial healing of duodenal ulcers and a significant benefit in preventing the recurrence of both gastric and duodenal ulcers once healing has been achieved. In summary, when people with peptic ulcers have Helicobacter pylori infection, antibiotic treatment can help speed initial healing of some ulcers and can prevent ulcers returning

Authors' conclusions: 

A one to two weeks course of H. pylori eradication therapy is an effective treatment for H. pylori positive peptic ulcer disease.

Read the full abstract...
Background: 

Peptic ulcer disease is the cause for dyspepsia in about 10% of patients. 95% of duodenal and 70% of gastric ulcers are associated with Helicobacter pylori. Eradication of H. pylori reduces the relapse rate of ulcers but the magnitude of this effect is uncertain.

Objectives: 

The primary outcomes were the proportion of peptic ulcers healed initially and proportion of patients free from relapse following successful healing. Eradication therapy was compared to placebo or pharmacological therapies in H. pylori positive patients. Secondary aims included symptom relief and adverse effects.

Search strategy: 

Trials were identified by searching MEDLINE (1950 to August 2010), EMBASE (1980 to 2010 week 35), and the Cochrane Central Register of Controlled Trials (Issue 2, 2010). Reference lists from trials selected by electronic searching were handsearched to identify further relevant trials. Published abstracts from conference proceedings from the United European Gastroenterology Week (published in Gut) and Digestive Disease Week (published in Gastroenterology) were handsearched. The search was updated in September 2003, November 2004, November 2005, July 2008, and August 2010. Members of the Cochrane UGPD Group, and experts in the field were contacted and asked to provide details of outstanding clinical trials and any relevant unpublished materials

Selection criteria: 

Randomised controlled trials of short and long-term treatment of peptic ulcer disease in H. pylori positive adults were analysed. Patients received at least one week of H pylori eradication compared with ulcer healing drug, placebo or not treatment. Trials were included if they reported assessment from two weeks onwards.

Data collection and analysis: 

Data were collected on ulcer healing, recurrence, relief of symptoms and adverse effects.

Main results: 

Sixty four trials were eligible. Data extraction was not possible in seven trials, and 57 trials were included. In duodenal ulcer healing, eradication therapy was superior to ulcer healing drug (UHD) (34 trials, 3910 patients, relative risk (RR) of ulcer persisting = 0.66, 95% confidence interval (CI) 0.58 to 0.76) and no treatment (two trials, 207 patients, RR 0.37, 95% CI 0.26 to 0.53). In gastric ulcer healing, no significant differences were detected between eradication therapy and UHD (15 trials, 1974 patients, RR 1.23, 95% CI 0.90 to 1.68). In preventing duodenal ulcer recurrence no significant differences were detected between eradication therapy and maintenance therapy with UHD (four trials, 319 patients, RR of ulcer recurring 0.73; 95% CI 0.42 to 1.25), but eradication therapy was superior to no treatment (27 trials 2509 patients, RR 0.20, 95% CI 0.15 to 0.26). In preventing gastric ulcer recurrence, eradication therapy was superior to no treatment (12 trials, 1476 patients, RR 0.31, 95% CI 0.22 to 0.45).