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H. pylori treatment in long-term PPI users

Can eradication of Helicobacter pylori decrease symptoms and proton pump inhibitor (PPI) use in long-term users?

Can eradication of Helicobacter pylori decrease symptoms and proton pump inhibitor (PPI) use in long-term users?

Synopsis

The investigators performing this study evaluated patients identified from 13 primary care practices in England who used PPIs for at least 12 months.

The patients stopped their PPI use for two weeks and underwent evaluation for H. pylori status; 28% were positive.

These 184 patients were randomly assigned, using concealed allocation, to receive placebo or one-week triple therapy for H. pylori eradication.

PPI use and office visits were monitored for 12 months, and dyspepsia and reflux symptoms were measured, along with quality of life, after 12 months. H. pylori was eradicated in 94% of patients.

Over one year, PPI prescriptions were significantly reduced in the treated patients, from 9.2 to 7.4 prescriptions, whereas prescription rates remained the same in the placebo-treated patients.

The decrease in prescriptions was higher for patients receiving full-dose PPI. On average, treated patients had one fewer visit over the year than untreated patients.

Dyspepsia was lower in the treated patients, but not reflux symptoms. Quality of life was not affected by treatment.

Level of evidence

1b (see www.infopoems.com/concept/ ebm_loe.cfm)

Reference

Raghunath AS, Hungin AP, Mason J, Jackson W. Helicobacter pylori eradication in long-term proton pump inhibitor users in primary care: a randomised trial. Aliment Pharmacol Ther 2007;25:585-92.

Bottom line

Identification and eradication of H. pylori in long-term users of PPIs results in a small decrease in their use of PPIs over the following year and fewer return visits. Dyspepsia symptoms were decreased; reflux symptoms were not.

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