HP eradication: effective for cure (NNT = 14) or improvement (NNT = 9) of functional dyspepsia, especially if eradication is confirmed (NNT = 6)

Reference

Ford AC, Tsipotis E, Yuan Y, Leontiadis GI, Moayyedi P. Efficacy of Helicobacter pylori eradication therapy for functional dyspepsia: updated systematic review and meta-analysis. Gut 2022;71:1967-1975.

Synopsis

This systematic review updated a 15-year-old Cochrane review with 10 new trials and 2896 patients, for a total of 29 trials and 6781 patients. The authors did the usual high-quality Cochrane systematic review to identify randomized trials with at least 3 months of follow-up, using a random effects meta-analysis. Only 6 studies were classified as having a low risk of bias, with the most common problems being unclear allocation concealment and unclear complete outcome reporting. Based on 18 studies with 4564 patients, Helicobacter pylori (HP) eradication therapy decreased the likelihood of failure to cure functional dyspepsia (relative risk [RR] = 0.91; 95% CI 0.88 - 0.94; I2 = 7%; number needed to treat [NNT] = 14). However, there was some evidence for publication bias, suggesting that smaller negative trials were not published. The benefit was consistent regardless of the comparator (placebo or antisecretory therapy) or study quality. Based on 22 studies with 5193 patients, HP eradication therapy also decreased the likelihood of failure to improve symptoms without evidence of publication bias but moderate heterogeneity (RR 0.84; 0.78 - 0.91; I2 = 69%; NNT = 9). In 16 studies reporting whether eradication was successful, patients with successful eradication were significantly less likely to fail to improve or to fail to be cured than those who received the comparator (RR 0.74; 0.64 - 0.85; I2 = 82%; NNT = 6). However, there was significant heterogeneity, and funnel plot asymmetry suggests possible publication bias.