Objective To evaluate the clinical effectiveness of helicobacter pylori (HP) eradication in treating functional dyspepsia (FD) patients with HP infection. Methods The randomized controlled trials (RCTs) about HP eradication vs. general treatment for FD patients published by April, 2012 were searched in the following databases: CBM, CNKI, WanFang Data, PubMed, Ovid, EMbase and The Cochrane Library (Issue 1, 2012). According to the inclusion and exclusion criteria, two reviewers independently screened studies, extracted data, and evaluated the methodological quality. Then the meta-analysis was conducted using RevMan 5.1 software. Results The total 14 RCTs were included. Among all 2 665 patients involved in, 1 339 were in the treatment group, while the other 1 326 were in the control group. The results of meta-analysis showed that HP eradication was superior to general treatment for FD patients in clinical effects (RR=3.90, 95%CI 3.08 to 4.94, Plt;0.000 01), symptomatic score (WMD=−1.68, 95%CI −1.88 to −1.47, Plt;0.000 01), and improvement of upper abdominal pain (RR=2.84, 95%CI 2.02 to 3.99, Plt;0.000 01). Conclusion With obviously clinical effects, HP eradication can decrease the symptomatic score of dyspepsia, and especially improve upper abdominal pain. For the quality and quantity limitations of the included studies, more well-designed and double blind RCTs are required to further prove this conclusion.
Objective To provide evidence of the role of helicobacter pylori eradication in the treatment of functional dyspepsia. Methods We searched VIP, CBMdisc, MEDLINE and The Cochrane Library for systematic reviews, meta-analysis, randomized controlled trials and clinical guidelines involving helicobacter pylori and functional dyspepsia, so as to provide the best evidence for clinical practice. Results We included two systematic reviews, one meta-analysis and eleven randomized controlled trials. The evidence identified showed that helicobacter pylori infection was more prevalent in functional dyspepsia than in asymptomatic patients, but the effect of H pylori infection in the pathogenesis of functional dyspepsia remained controversial. H pylori eradication therapy had a relatively weak effect in H pylori positive functional dyspepsia. An economic model suggested that this modest benefit may still be cost-effective, but more studies are needed to assess this. Conclusion According to the current evidence, it can be concluded that helicobacter pylori eradication for the treatment of functional dyspepsia should be individualized.
Objective We aimed to evaluate the prevalence of H.pylori infection and the prevalence of cagA+ strains in patients with and without Barrett’s esophagus. Methods A full literature search to February 2008 was conducted in PubMed, MEDLINE and EMbase databases to identify case-control studies or cohort studies evaluating the prevalence of H.pylori in patients with or without Barrett’s esophagus. Summary odds ratios (OR) and 95% confidence interval (CI) were calculated by RevMan 4.2.8. Results Nineteen studies were identified (16 case-controlled studies and 3 cohort studies). In case controlled studies, the prevalence of H.pylori infection significantly decreased in patients with Barrett’s esophagus as compared subjects with normal endoscopic appearance, with a overall OR of 0.56 (95%CI 0.40 to 0.79). The prevalence of H.pylori infection was no statistically significant difference in patients with Barrett’s esophagus as compared to those with gastroesophageal reflux disease, with a overall OR of 0.86 (95% CI 0.74 to 1.00). In cohort studies, the prevalence of H. pylori was no statistically significant difference in patients with Barrett’s esophagus as compared to patients with normal endoscopic appearance or patients with gastroesophageal reflux disease, with a overall OR of 1.12 (95%CI 0.77 to 1.61) and 1.10 (95%CI 0.32 to 3.83). When the analysis was stratified by the status of cagA, the prevalence of cagA positive strains significantly decreased in patients with Barrett’s esophagus as compared both to subjects with normal endoscopic appearance with OR 0.30 and 95% CI 0.12 to 0.74, and to those with gastroesophageal reflux disease (OR 0.55; 95%CI 0.33 to 0.94). Irrespective of the presence of intestinal metaplasia, similar magnitude for the reduction of H.pylori infection was observed for patients with Barrett’s esophagus and those with normal endoscopic appearance. While accompared with the presence of intestinal metaplasia, Barrett’s esophagus was associated with a significantly reduction as compared to the patients with gastroesophageal reflux disease (OR 0.81, 95%CI 0.68 to 0.98). When stratified analyses were performed, a significant reduction of H.pylori infection was observed only in patients with long-segment Barrett’s esophagus (OR 0.54; 95%CI 0.35 to 0.82), but not in those with short-segment Barrett’s esophagus (OR 0.72; 95%CI 0.43 to 1.20). Conclusion This meta-analysis indicated that the prevalence of H.pylori infection, especially the prevalence of cagA positive strains was significantly lower in patients with Barrett’s esophagus than in subjects with normal endoscopic appearance. However, the prevalence of H. pylori infection was no statistical difference in patients with Barrett’s esophagus as compared to those with gastroesophageal reflux disease. Colonization with cagA positive strains may be protective against the formation of Barrett’s esophagus.
ObjectiveTo study the relationship between cholecystectomy and Helicobacter pylori （Hp） infection. MethodsOne hundred and eleven patients with cholecystolithiasis were chosen as the investigation group, while 577 patients with upper digestive tract symptoms without cholecystolithiasis as the control group. All the patients took the 13C breath test to determine whether they were infected by Hp. All the patients with Hp infection continued eradical therapy for Hp infection for one course after cholecystectomy and were followed up on outpatient basis. ResultsThe infection rate in the investigation group was 45.9%, while 27.4% in the control group. During the 3 to 6 months of followup for the patients undergoing eradical therapy for Hp infection, we found no patient complaining of epigastric pain, malaise, belching and nausea. ConclusionThe infection rate of Hp in patients with cholecystolithiasis is high, Hp may be one of the factors causing “postcholecystectomy syndrome”. Eradical therapy for Hp after cholecystectomy will help improve the effects of operation.
ObjectiveTo study the expression of cyclooxygenase2 (COX2) and its clinical significance in gastric carcinoma. MethodsThe expression of COX2 in 47 cases of gastric carcinoma and 16 cases of normal gastric tissue were detected by SP immunohistochemical technique. Helicobacter pylori (H.pylori) infection was diagnosed by urease experiment and Giemsa staining.ResultsThere was no positive signal of COX2 detected in normal gastric tissue. The positive expression rate of COX2 was 63.8%(30/47) in gastric carcinoma.The expression of COX2 was correlated with TNM stage, lymph node metastasis and H.pylori infection（P＜0.01）. Positive COX2 expression rate in H.pylori infection group was 72.4%(21/29), significantly higher than that in the group without H.pylori infection.Conclusion COX2 expression is involved in the carcinogenesis and malignant progression of gastric carcinoma.The examination of COX2 may be helpful to judge biological behavior of gastric carcinoma.
Serum tumor markers CEA, CA19-9, CA72-4 and Helicobacter pylori (H.pylori) antibodies were measured in 162 patients with gastric cancer. CEA, CA19-9 and CA72-4 had sensitivities of 24.0%, 35.5% and 21.9% respectively. CA72-4 provided 100% specifity, compared to 77% and 93% for CA19-9 and CEA. The positive predictive value (PV) in CEA, CA19-9 and CA72-4 was higher than negative PV. Serum CA19-9 and CA72-4 levels rose in tumor of ＞5.0cm in diameter. The CA19-9 increased remarkably when the deeper stomach wall was invased. The significantly elevated CEA, CA72-4 and CA19-9 levels were found in patients who had nodal involvement in more than 50% and distant metastasis. However, the increase of CEA, CA19-9 and CA72-4 were found in undifferentiated tumor. Antibodies to H.pylori were detected in 54% of patients but in only 22% control subjects. A significant association was found between H.pylori infection and gastric cancer (odds ratio=3.75; 95% confidence interval=2.11-5.41, Ｐ＜0.01). Conclusions: CEA, CA19-9 and CA72-4 have higher specifity but lower sensitivity in diagnosis of the gastric cancer. The levels of CEA, CA19-9 and CA72-4 are significantly associated with the diameter, the depth of invasion, nodal involvement, distant metastasis and cell differention. Infection with H.pylori may be an important cause of gastric cancer.
Helicobacter pylori (HP) infection is closely associated with the occurrence of such common upper gastrointestinal diseases as chronic gastritis, peptic ulcer and gastric cancer. However, even with the currently most effective treatment regimens, approximately 10% to 20% of patients still fail to obtain eradication of the infection and remain HP positive. So the eradication of HP infection remains one of the major challenges in the medical field. This article aims to introduce the evidence for the choice of the second-line regimens after the failure of the first therapy. And the evidence includes the quadruple therapy proposed by the Maastricht III Consensus and the triple regimens with different antibiotics in all kinds of randomized clinical trials.
Objective To make an individualized treatment plan for one first-visit gastro-esophageal reflux disease patient via evidence-based medicine methods. Methods The condition of the patient was evaluated comprehensively, then clinical problems were put forward according to PICO principle, and high-quality evidence was collected from The Cochrane Library (1990 to 2010), PubMed (1990 to 2010), and EMbase (1990 to 2010). The treatment plan was designed based on the evaluation of evidence, doctor’s experience, and patient’s preferences. Results A total of 17 RCTs and 10 meta-analyses/ systematic reviews were included. The evidence showed that the therapeutic effect of PPI was better than that of H2RA, and meanwhile prokinetic drugs should be used. When PPI needed to be use for a long time, HP eradication operation was required for the combination of HP inflammation. Laparoscopic fundoplication surgery was a better choice if the operation was required. Based on the above evidence combined with the patient’s preferences, the combination of general treatment, esomeprazole and cisaPride were adopted to treat. Meanwhile, anti-HP medicine was used to control the HP inflammation caused by the long-term maintenance therapy. The gastro-esophageal reflux symptoms were remarkably relieved six months after the treatment. Conclusion PPI plus prokinetic drugs, combined with HP eradication of gastroesophageal reflux surgery, can improve the clinical outcomes and patient’s quality of life. However, long-term prognostic benefits need to be confirmed by further follow-up.
Objective To evaluate the efficacy and safety of furazolidone-based first-line therapy for Helicobacter pylori infection. Methods The randomized controlled trials (RCTs) of furazolidone-based first-line therapy for Helicobacter pylori infection were identified from Cochrane Library (Issue 1, 2009), PubMed (1992 to January 2009), OVID (1994 to January 2009), Wanfang Data (1994 to January 2009), CNKI (1994 to January 2009), and VIP Data (1994 to January 2009). The quality of included RCTs was assessed, and the meta-analysis was conducted with RevMan5.0 software. Results Among five included RCTs involving 499 patients, four were graded as B in methodology quality and the left one was graded as C. As to the intention-to-treat (ITT) analysis, the Helicobacter pylori eradication rate was 78.3% in furazolidone group and 66.8% in control group (RR=1.18, 95%CI 0.86 to 1.62), while the Per Protocol (PP) analysis, the eradication rate of furazolidone group and control group was 83.1% and 70.9% respectively (RR=1.17, 95%CI 0.88 to 1.57). The incidence rate of mild side-effects was 40.8% in furazolidone group and 39.4% in control group (RR=1.03, 95%CI 0.79 to 1.36), and while that of severe side-effects in furazolidone group and control group was 7.8% and 3.7% respectively (RR=1.86, 95%CI 0.84 to 4.09). Conclusions With similar efficacy and safety as control group has, the furazolidone-based therapy could be recommended as a first-line therapy for Helicobacter pylori infection. The high-quality RCTs with large sample are required to prove the above conclusion for the limitation of quantity and quality of included studies.
Objective To systematically review the relationship between helicobacter pyloric (HP) infection and ischemia stroke. Methods We searched MEDLINE, BIOSIS, VIP, and China Full Text Journal databases to identify the studies that studied the relationship between HP infection and ischemia stroke. All the studies were strictly screened according to the inclusion criteria, and meta-analyses were performed for the included studies using RevMan 4.2 software.Results Eleven case-control studies involving 1 530 patients with ischemia stroke and 1 451 health controls were included. The results of meta-analyses showed that there was a significant difference in the infection ratio of HP between the patients with ischemia stroke and health controls (OR=1.77, 95%CI 1.38 to 2.28, Plt;0.0001), but this difference was not been found after adjusting some related risk factors (1.22, 95%CI 0.93 to 1.59, P=0.15). The results of subgroup meta-analyses showed these differences were only found in the LAA (large-artery atherosclerosis) subgroup (OR=3.65, 95%CI 2.58 to 5.17) and the SAA (small-artery atherosclerosis) subgroup (OR=1.74, 95%CI 1.30 to 2.34), but was not found in the CE (cardiogenic cerebral embolism) subgroup (OR=1.08, 95%CI 0.58 to 2.02). Conclusion HP infection is associated with ischemia stroke, but the relationships between HP infection and the subtypes of ischemia stroke are different. The association between HP and LAA is ber than that between HP and the other subtypes. More evidence is needed to prove whether Helicobacter pyloric infection is an independent risk factor of ischemia stroke.