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Javier P Gisbert - One of the best experts on this subject based on the ideXlab platform.
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helicobacter pylori Eradication Therapy vs antisecretory non Eradication Therapy with or without long term maintenance antisecretory Therapy for the prevention of recurrent bleeding from peptic ulcer
Cochrane Database of Systematic Reviews, 2004Co-Authors: Javier P Gisbert, Sam Khorrami, Fernando Carballo, Xavier Calvet, Emili Gene, Enrique DominguezmunozAbstract:Background Peptic ulcer is the main cause for upper gastrointestinal haemorrhage, and Helicobacter pylori (H.pylori) infection is the main etiologic factor for peptic ulcer disease. Maintenance antisecretory Therapy is the standard long-term treatment for patients with bleeding ulcers to prevent recurrent bleeding. The efficacy of H. pylori Eradication for the prevention of rebleeding from peptic ulcer is unknown. Objectives To compare the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. Search methods We searched the Cochrane Controlled Trials Register (the Cochrane Library issue 4, 2003), MEDLINE (January 1966 to January 2004), EMBASE (January 1988 to January 2004), CINAHL (January 1982 to January 2004), and reference lists of articles. We also conducted a manual search from several congresses. The search strategy was re-run in January 2005 and October 2008, but no new trials were found. Selection criteria Controlled clinical trials comparing the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. Data collection and analysis Data extraction and quality assessment of studies was done by two reviewers. Study authors were contacted for additional information. Main results Seven studies with a total of 578 patients were included in the first comparison: mean percentage of rebleeding in H. pylori Eradication Therapy group was 2.9%, and in the non-Eradication Therapy group without subsequent long-term maintenance antisecretory Therapy it was 20% (OR 0.17, 95% CI 0.10 to 0.32; there was no statistical evidence of heterogeneity; NNT was 7, 95% CI 5 to 11). Three studies with a total of 470 patients were included in the second comparison: mean percentage of rebleeding in H. pylori Eradication Therapy group was 1.6%, and in non-Eradication Therapy group with long-term maintenance antisecretory Therapy it was 5.6% (OR 0.24, 95% CI 0.09 to 0.67; heterogeneity was not demonstrated; NNT was 20, 95% CI 12 to 100). Subgroup analyses were carried out to examine the effect of NSAIDS and of excluding H.pylori Eradication failures from the analyses. Authors' conclusions Treatment of H. pylori infection is more effective than antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) in preventing recurrent bleeding from peptic ulcer. All patients with peptic ulcer bleeding should be tested for H. pylori infection, and Eradication Therapy should be prescribed to H. pylori-positive patients.
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The Cochrane Library - Helicobacter pylori Eradication Therapy vs. antisecretory non‐Eradication Therapy (with or without long‐term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer
Cochrane Database of Systematic Reviews, 2004Co-Authors: Javier P Gisbert, Sam Khorrami, Fernando Carballo, Xavier Calvet, Emili Gene, Enrique Dominguez-muñozAbstract:Background Peptic ulcer is the main cause for upper gastrointestinal haemorrhage, and Helicobacter pylori (H.pylori) infection is the main etiologic factor for peptic ulcer disease. Maintenance antisecretory Therapy is the standard long-term treatment for patients with bleeding ulcers to prevent recurrent bleeding. The efficacy of H. pylori Eradication for the prevention of rebleeding from peptic ulcer is unknown. Objectives To compare the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. Search methods We searched the Cochrane Controlled Trials Register (the Cochrane Library issue 4, 2003), MEDLINE (January 1966 to January 2004), EMBASE (January 1988 to January 2004), CINAHL (January 1982 to January 2004), and reference lists of articles. We also conducted a manual search from several congresses. The search strategy was re-run in January 2005 and October 2008, but no new trials were found. Selection criteria Controlled clinical trials comparing the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. Data collection and analysis Data extraction and quality assessment of studies was done by two reviewers. Study authors were contacted for additional information. Main results Seven studies with a total of 578 patients were included in the first comparison: mean percentage of rebleeding in H. pylori Eradication Therapy group was 2.9%, and in the non-Eradication Therapy group without subsequent long-term maintenance antisecretory Therapy it was 20% (OR 0.17, 95% CI 0.10 to 0.32; there was no statistical evidence of heterogeneity; NNT was 7, 95% CI 5 to 11). Three studies with a total of 470 patients were included in the second comparison: mean percentage of rebleeding in H. pylori Eradication Therapy group was 1.6%, and in non-Eradication Therapy group with long-term maintenance antisecretory Therapy it was 5.6% (OR 0.24, 95% CI 0.09 to 0.67; heterogeneity was not demonstrated; NNT was 20, 95% CI 12 to 100). Subgroup analyses were carried out to examine the effect of NSAIDS and of excluding H.pylori Eradication failures from the analyses. Authors' conclusions Treatment of H. pylori infection is more effective than antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) in preventing recurrent bleeding from peptic ulcer. All patients with peptic ulcer bleeding should be tested for H. pylori infection, and Eradication Therapy should be prescribed to H. pylori-positive patients.
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meta analysis helicobacter pylori Eradication Therapy vs antisecretory non Eradication Therapy for the prevention of recurrent bleeding from peptic ulcer
Alimentary Pharmacology & Therapeutics, 2004Co-Authors: Javier P Gisbert, Sam Khorrami, Fernando Carballo, Xavier Calvet, Emili Gene, Enrique DominguezmunozAbstract:Summary Aim : To perform a meta-analysis comparing the efficacy of Helicobacter pylori Eradication Therapy vs. antisecretory non-Eradication Therapy for the prevention of recurrent bleeding from peptic ulcer. Methods : A search was made of the Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL and several congresses for controlled clinical trials comparing the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy for the prevention of peptic ulcer re-bleeding. Studies with all patients taking non-steroidal anti-inflammatory drugs were excluded. Extraction and quality assessment of the studies were performed by two reviewers. Results : In the first meta-analysis, the mean percentage of re-bleeding in the H. pylori Eradication Therapy group was 4.5%, compared with 23.7% in the non-Eradication Therapy group without long-term antisecretory Therapy [odds ratio, 0.18; 95% confidence interval (CI), 0.09–0.37; ‘number needed to treat’ (NNT), 5; 95% CI, 4–8]. In the second meta-analysis, the re-bleeding rate in the H. pylori Eradication Therapy group was 1.6%, compared with 5.6% in the non-Eradication Therapy group with maintenance antisecretory Therapy (odds ratio, 0.25; 95% CI, 0.08–0.76; NNT, 20; 95% CI, 12–100). When only patients with successful H. pylori Eradication were included, the re-bleeding rate was 1%. Conclusions : The treatment of H. pylori infection is more effective than antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory treatment) in the prevention of recurrent bleeding from peptic ulcer. Consequently, all patients with peptic ulcer bleeding should be tested for H. pylori, and Eradication Therapy should be prescribed to infected patients.
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H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer.
The Cochrane database of systematic reviews, 2003Co-Authors: Javier P Gisbert, Sam Khorrami, Fernando Carballo, Xavier Calvet, Emili Gene, J E Dominguez-muñozAbstract:Peptic ulcer is the main cause for upper gastrointestinal haemorrhage, and Helicobacter pylori infection is the main etiologic factor for peptic ulcer disease. Maintenance antisecretory Therapy has been the standard long-term treatment for patients with bleeding ulcers to prevent recurrent bleeding. On the other hand, the precise efficacy of H. pylori Eradication for the prevention of rebleeding from peptic ulcer is unknown. To compare the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. We searched the Cochrane Controlled Trials Register (the Cochrane Library issue 1, 2003), MEDLINE (January 1966 to March 2003), EMBASE (January 1988 to March 2003), CINAHL (January 1982 to March 2003), and reference lists of articles. We also conducted a manual search from several congresses. Controlled clinical trials comparing the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. Extraction and quality assessment of studies were done by two reviewers. Study authors were contacted for additional information. Six studies with a total of 355 patients were included in the first meta-analysis: mean percentage of rebleeding in H. pylori Eradication Therapy group was 4.5%, and in the non-Eradication Therapy group without subsequent long-term maintenance antisecretory Therapy it was 23.7% (OR 0.18, 95% CI 0.09 to 0.37; there was no statistical evidence of heterogeneity; NNT was 5, 95% CI 4 to 8). Three studies with a total of 470 patients were included in the second meta-analysis: mean percentage of rebleeding in H. pylori Eradication Therapy group was 1.6%, and in non-Eradication Therapy group with long-term maintenance antisecretory Therapy it was 5.6% (OR 0.25, 95% CI 0.08 to 0.76; heterogeneity was not demonstrated; NNT was 20, 95% CI 12 to 100). Subanalysis. Excluding patients taking non-steroidal anti-inflammatory drugs (NSAIDs) at the time of recurrent bleeding resulted in a rebleeding rate of 4% (first meta-analysis) or 0.78% (second meta-analysis) in the group receiving H. pylori Eradication Therapy. When only patients with H. pylori Eradication success were included, rebleeding rate was 1% in H. pylori Eradication Therapy group, and NNT decreased from 5 to 4. In some cases, recurrence of H. pylori infection seemed to be responsible for recurrence of bleeding. Treatment of H. pylori infection is more effective than antisecretory non-eradicating Therapy (with or without long-term maintenance antisecretory Therapy) in preventing recurrent bleeding from peptic ulcer. Consequently, all patients with peptic ulcer bleeding should be tested for H. pylori infection, and Eradication Therapy should be prescribed to H. pylori-positive patients.
Sam Khorrami - One of the best experts on this subject based on the ideXlab platform.
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helicobacter pylori Eradication Therapy vs antisecretory non Eradication Therapy with or without long term maintenance antisecretory Therapy for the prevention of recurrent bleeding from peptic ulcer
Cochrane Database of Systematic Reviews, 2004Co-Authors: Javier P Gisbert, Sam Khorrami, Fernando Carballo, Xavier Calvet, Emili Gene, Enrique DominguezmunozAbstract:Background Peptic ulcer is the main cause for upper gastrointestinal haemorrhage, and Helicobacter pylori (H.pylori) infection is the main etiologic factor for peptic ulcer disease. Maintenance antisecretory Therapy is the standard long-term treatment for patients with bleeding ulcers to prevent recurrent bleeding. The efficacy of H. pylori Eradication for the prevention of rebleeding from peptic ulcer is unknown. Objectives To compare the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. Search methods We searched the Cochrane Controlled Trials Register (the Cochrane Library issue 4, 2003), MEDLINE (January 1966 to January 2004), EMBASE (January 1988 to January 2004), CINAHL (January 1982 to January 2004), and reference lists of articles. We also conducted a manual search from several congresses. The search strategy was re-run in January 2005 and October 2008, but no new trials were found. Selection criteria Controlled clinical trials comparing the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. Data collection and analysis Data extraction and quality assessment of studies was done by two reviewers. Study authors were contacted for additional information. Main results Seven studies with a total of 578 patients were included in the first comparison: mean percentage of rebleeding in H. pylori Eradication Therapy group was 2.9%, and in the non-Eradication Therapy group without subsequent long-term maintenance antisecretory Therapy it was 20% (OR 0.17, 95% CI 0.10 to 0.32; there was no statistical evidence of heterogeneity; NNT was 7, 95% CI 5 to 11). Three studies with a total of 470 patients were included in the second comparison: mean percentage of rebleeding in H. pylori Eradication Therapy group was 1.6%, and in non-Eradication Therapy group with long-term maintenance antisecretory Therapy it was 5.6% (OR 0.24, 95% CI 0.09 to 0.67; heterogeneity was not demonstrated; NNT was 20, 95% CI 12 to 100). Subgroup analyses were carried out to examine the effect of NSAIDS and of excluding H.pylori Eradication failures from the analyses. Authors' conclusions Treatment of H. pylori infection is more effective than antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) in preventing recurrent bleeding from peptic ulcer. All patients with peptic ulcer bleeding should be tested for H. pylori infection, and Eradication Therapy should be prescribed to H. pylori-positive patients.
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The Cochrane Library - Helicobacter pylori Eradication Therapy vs. antisecretory non‐Eradication Therapy (with or without long‐term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer
Cochrane Database of Systematic Reviews, 2004Co-Authors: Javier P Gisbert, Sam Khorrami, Fernando Carballo, Xavier Calvet, Emili Gene, Enrique Dominguez-muñozAbstract:Background Peptic ulcer is the main cause for upper gastrointestinal haemorrhage, and Helicobacter pylori (H.pylori) infection is the main etiologic factor for peptic ulcer disease. Maintenance antisecretory Therapy is the standard long-term treatment for patients with bleeding ulcers to prevent recurrent bleeding. The efficacy of H. pylori Eradication for the prevention of rebleeding from peptic ulcer is unknown. Objectives To compare the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. Search methods We searched the Cochrane Controlled Trials Register (the Cochrane Library issue 4, 2003), MEDLINE (January 1966 to January 2004), EMBASE (January 1988 to January 2004), CINAHL (January 1982 to January 2004), and reference lists of articles. We also conducted a manual search from several congresses. The search strategy was re-run in January 2005 and October 2008, but no new trials were found. Selection criteria Controlled clinical trials comparing the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. Data collection and analysis Data extraction and quality assessment of studies was done by two reviewers. Study authors were contacted for additional information. Main results Seven studies with a total of 578 patients were included in the first comparison: mean percentage of rebleeding in H. pylori Eradication Therapy group was 2.9%, and in the non-Eradication Therapy group without subsequent long-term maintenance antisecretory Therapy it was 20% (OR 0.17, 95% CI 0.10 to 0.32; there was no statistical evidence of heterogeneity; NNT was 7, 95% CI 5 to 11). Three studies with a total of 470 patients were included in the second comparison: mean percentage of rebleeding in H. pylori Eradication Therapy group was 1.6%, and in non-Eradication Therapy group with long-term maintenance antisecretory Therapy it was 5.6% (OR 0.24, 95% CI 0.09 to 0.67; heterogeneity was not demonstrated; NNT was 20, 95% CI 12 to 100). Subgroup analyses were carried out to examine the effect of NSAIDS and of excluding H.pylori Eradication failures from the analyses. Authors' conclusions Treatment of H. pylori infection is more effective than antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) in preventing recurrent bleeding from peptic ulcer. All patients with peptic ulcer bleeding should be tested for H. pylori infection, and Eradication Therapy should be prescribed to H. pylori-positive patients.
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meta analysis helicobacter pylori Eradication Therapy vs antisecretory non Eradication Therapy for the prevention of recurrent bleeding from peptic ulcer
Alimentary Pharmacology & Therapeutics, 2004Co-Authors: Javier P Gisbert, Sam Khorrami, Fernando Carballo, Xavier Calvet, Emili Gene, Enrique DominguezmunozAbstract:Summary Aim : To perform a meta-analysis comparing the efficacy of Helicobacter pylori Eradication Therapy vs. antisecretory non-Eradication Therapy for the prevention of recurrent bleeding from peptic ulcer. Methods : A search was made of the Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL and several congresses for controlled clinical trials comparing the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy for the prevention of peptic ulcer re-bleeding. Studies with all patients taking non-steroidal anti-inflammatory drugs were excluded. Extraction and quality assessment of the studies were performed by two reviewers. Results : In the first meta-analysis, the mean percentage of re-bleeding in the H. pylori Eradication Therapy group was 4.5%, compared with 23.7% in the non-Eradication Therapy group without long-term antisecretory Therapy [odds ratio, 0.18; 95% confidence interval (CI), 0.09–0.37; ‘number needed to treat’ (NNT), 5; 95% CI, 4–8]. In the second meta-analysis, the re-bleeding rate in the H. pylori Eradication Therapy group was 1.6%, compared with 5.6% in the non-Eradication Therapy group with maintenance antisecretory Therapy (odds ratio, 0.25; 95% CI, 0.08–0.76; NNT, 20; 95% CI, 12–100). When only patients with successful H. pylori Eradication were included, the re-bleeding rate was 1%. Conclusions : The treatment of H. pylori infection is more effective than antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory treatment) in the prevention of recurrent bleeding from peptic ulcer. Consequently, all patients with peptic ulcer bleeding should be tested for H. pylori, and Eradication Therapy should be prescribed to infected patients.
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H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer.
The Cochrane database of systematic reviews, 2003Co-Authors: Javier P Gisbert, Sam Khorrami, Fernando Carballo, Xavier Calvet, Emili Gene, J E Dominguez-muñozAbstract:Peptic ulcer is the main cause for upper gastrointestinal haemorrhage, and Helicobacter pylori infection is the main etiologic factor for peptic ulcer disease. Maintenance antisecretory Therapy has been the standard long-term treatment for patients with bleeding ulcers to prevent recurrent bleeding. On the other hand, the precise efficacy of H. pylori Eradication for the prevention of rebleeding from peptic ulcer is unknown. To compare the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. We searched the Cochrane Controlled Trials Register (the Cochrane Library issue 1, 2003), MEDLINE (January 1966 to March 2003), EMBASE (January 1988 to March 2003), CINAHL (January 1982 to March 2003), and reference lists of articles. We also conducted a manual search from several congresses. Controlled clinical trials comparing the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. Extraction and quality assessment of studies were done by two reviewers. Study authors were contacted for additional information. Six studies with a total of 355 patients were included in the first meta-analysis: mean percentage of rebleeding in H. pylori Eradication Therapy group was 4.5%, and in the non-Eradication Therapy group without subsequent long-term maintenance antisecretory Therapy it was 23.7% (OR 0.18, 95% CI 0.09 to 0.37; there was no statistical evidence of heterogeneity; NNT was 5, 95% CI 4 to 8). Three studies with a total of 470 patients were included in the second meta-analysis: mean percentage of rebleeding in H. pylori Eradication Therapy group was 1.6%, and in non-Eradication Therapy group with long-term maintenance antisecretory Therapy it was 5.6% (OR 0.25, 95% CI 0.08 to 0.76; heterogeneity was not demonstrated; NNT was 20, 95% CI 12 to 100). Subanalysis. Excluding patients taking non-steroidal anti-inflammatory drugs (NSAIDs) at the time of recurrent bleeding resulted in a rebleeding rate of 4% (first meta-analysis) or 0.78% (second meta-analysis) in the group receiving H. pylori Eradication Therapy. When only patients with H. pylori Eradication success were included, rebleeding rate was 1% in H. pylori Eradication Therapy group, and NNT decreased from 5 to 4. In some cases, recurrence of H. pylori infection seemed to be responsible for recurrence of bleeding. Treatment of H. pylori infection is more effective than antisecretory non-eradicating Therapy (with or without long-term maintenance antisecretory Therapy) in preventing recurrent bleeding from peptic ulcer. Consequently, all patients with peptic ulcer bleeding should be tested for H. pylori infection, and Eradication Therapy should be prescribed to H. pylori-positive patients.
Fernando Carballo - One of the best experts on this subject based on the ideXlab platform.
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helicobacter pylori Eradication Therapy vs antisecretory non Eradication Therapy with or without long term maintenance antisecretory Therapy for the prevention of recurrent bleeding from peptic ulcer
Cochrane Database of Systematic Reviews, 2004Co-Authors: Javier P Gisbert, Sam Khorrami, Fernando Carballo, Xavier Calvet, Emili Gene, Enrique DominguezmunozAbstract:Background Peptic ulcer is the main cause for upper gastrointestinal haemorrhage, and Helicobacter pylori (H.pylori) infection is the main etiologic factor for peptic ulcer disease. Maintenance antisecretory Therapy is the standard long-term treatment for patients with bleeding ulcers to prevent recurrent bleeding. The efficacy of H. pylori Eradication for the prevention of rebleeding from peptic ulcer is unknown. Objectives To compare the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. Search methods We searched the Cochrane Controlled Trials Register (the Cochrane Library issue 4, 2003), MEDLINE (January 1966 to January 2004), EMBASE (January 1988 to January 2004), CINAHL (January 1982 to January 2004), and reference lists of articles. We also conducted a manual search from several congresses. The search strategy was re-run in January 2005 and October 2008, but no new trials were found. Selection criteria Controlled clinical trials comparing the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. Data collection and analysis Data extraction and quality assessment of studies was done by two reviewers. Study authors were contacted for additional information. Main results Seven studies with a total of 578 patients were included in the first comparison: mean percentage of rebleeding in H. pylori Eradication Therapy group was 2.9%, and in the non-Eradication Therapy group without subsequent long-term maintenance antisecretory Therapy it was 20% (OR 0.17, 95% CI 0.10 to 0.32; there was no statistical evidence of heterogeneity; NNT was 7, 95% CI 5 to 11). Three studies with a total of 470 patients were included in the second comparison: mean percentage of rebleeding in H. pylori Eradication Therapy group was 1.6%, and in non-Eradication Therapy group with long-term maintenance antisecretory Therapy it was 5.6% (OR 0.24, 95% CI 0.09 to 0.67; heterogeneity was not demonstrated; NNT was 20, 95% CI 12 to 100). Subgroup analyses were carried out to examine the effect of NSAIDS and of excluding H.pylori Eradication failures from the analyses. Authors' conclusions Treatment of H. pylori infection is more effective than antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) in preventing recurrent bleeding from peptic ulcer. All patients with peptic ulcer bleeding should be tested for H. pylori infection, and Eradication Therapy should be prescribed to H. pylori-positive patients.
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The Cochrane Library - Helicobacter pylori Eradication Therapy vs. antisecretory non‐Eradication Therapy (with or without long‐term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer
Cochrane Database of Systematic Reviews, 2004Co-Authors: Javier P Gisbert, Sam Khorrami, Fernando Carballo, Xavier Calvet, Emili Gene, Enrique Dominguez-muñozAbstract:Background Peptic ulcer is the main cause for upper gastrointestinal haemorrhage, and Helicobacter pylori (H.pylori) infection is the main etiologic factor for peptic ulcer disease. Maintenance antisecretory Therapy is the standard long-term treatment for patients with bleeding ulcers to prevent recurrent bleeding. The efficacy of H. pylori Eradication for the prevention of rebleeding from peptic ulcer is unknown. Objectives To compare the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. Search methods We searched the Cochrane Controlled Trials Register (the Cochrane Library issue 4, 2003), MEDLINE (January 1966 to January 2004), EMBASE (January 1988 to January 2004), CINAHL (January 1982 to January 2004), and reference lists of articles. We also conducted a manual search from several congresses. The search strategy was re-run in January 2005 and October 2008, but no new trials were found. Selection criteria Controlled clinical trials comparing the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. Data collection and analysis Data extraction and quality assessment of studies was done by two reviewers. Study authors were contacted for additional information. Main results Seven studies with a total of 578 patients were included in the first comparison: mean percentage of rebleeding in H. pylori Eradication Therapy group was 2.9%, and in the non-Eradication Therapy group without subsequent long-term maintenance antisecretory Therapy it was 20% (OR 0.17, 95% CI 0.10 to 0.32; there was no statistical evidence of heterogeneity; NNT was 7, 95% CI 5 to 11). Three studies with a total of 470 patients were included in the second comparison: mean percentage of rebleeding in H. pylori Eradication Therapy group was 1.6%, and in non-Eradication Therapy group with long-term maintenance antisecretory Therapy it was 5.6% (OR 0.24, 95% CI 0.09 to 0.67; heterogeneity was not demonstrated; NNT was 20, 95% CI 12 to 100). Subgroup analyses were carried out to examine the effect of NSAIDS and of excluding H.pylori Eradication failures from the analyses. Authors' conclusions Treatment of H. pylori infection is more effective than antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) in preventing recurrent bleeding from peptic ulcer. All patients with peptic ulcer bleeding should be tested for H. pylori infection, and Eradication Therapy should be prescribed to H. pylori-positive patients.
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meta analysis helicobacter pylori Eradication Therapy vs antisecretory non Eradication Therapy for the prevention of recurrent bleeding from peptic ulcer
Alimentary Pharmacology & Therapeutics, 2004Co-Authors: Javier P Gisbert, Sam Khorrami, Fernando Carballo, Xavier Calvet, Emili Gene, Enrique DominguezmunozAbstract:Summary Aim : To perform a meta-analysis comparing the efficacy of Helicobacter pylori Eradication Therapy vs. antisecretory non-Eradication Therapy for the prevention of recurrent bleeding from peptic ulcer. Methods : A search was made of the Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL and several congresses for controlled clinical trials comparing the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy for the prevention of peptic ulcer re-bleeding. Studies with all patients taking non-steroidal anti-inflammatory drugs were excluded. Extraction and quality assessment of the studies were performed by two reviewers. Results : In the first meta-analysis, the mean percentage of re-bleeding in the H. pylori Eradication Therapy group was 4.5%, compared with 23.7% in the non-Eradication Therapy group without long-term antisecretory Therapy [odds ratio, 0.18; 95% confidence interval (CI), 0.09–0.37; ‘number needed to treat’ (NNT), 5; 95% CI, 4–8]. In the second meta-analysis, the re-bleeding rate in the H. pylori Eradication Therapy group was 1.6%, compared with 5.6% in the non-Eradication Therapy group with maintenance antisecretory Therapy (odds ratio, 0.25; 95% CI, 0.08–0.76; NNT, 20; 95% CI, 12–100). When only patients with successful H. pylori Eradication were included, the re-bleeding rate was 1%. Conclusions : The treatment of H. pylori infection is more effective than antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory treatment) in the prevention of recurrent bleeding from peptic ulcer. Consequently, all patients with peptic ulcer bleeding should be tested for H. pylori, and Eradication Therapy should be prescribed to infected patients.
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H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer.
The Cochrane database of systematic reviews, 2003Co-Authors: Javier P Gisbert, Sam Khorrami, Fernando Carballo, Xavier Calvet, Emili Gene, J E Dominguez-muñozAbstract:Peptic ulcer is the main cause for upper gastrointestinal haemorrhage, and Helicobacter pylori infection is the main etiologic factor for peptic ulcer disease. Maintenance antisecretory Therapy has been the standard long-term treatment for patients with bleeding ulcers to prevent recurrent bleeding. On the other hand, the precise efficacy of H. pylori Eradication for the prevention of rebleeding from peptic ulcer is unknown. To compare the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. We searched the Cochrane Controlled Trials Register (the Cochrane Library issue 1, 2003), MEDLINE (January 1966 to March 2003), EMBASE (January 1988 to March 2003), CINAHL (January 1982 to March 2003), and reference lists of articles. We also conducted a manual search from several congresses. Controlled clinical trials comparing the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. Extraction and quality assessment of studies were done by two reviewers. Study authors were contacted for additional information. Six studies with a total of 355 patients were included in the first meta-analysis: mean percentage of rebleeding in H. pylori Eradication Therapy group was 4.5%, and in the non-Eradication Therapy group without subsequent long-term maintenance antisecretory Therapy it was 23.7% (OR 0.18, 95% CI 0.09 to 0.37; there was no statistical evidence of heterogeneity; NNT was 5, 95% CI 4 to 8). Three studies with a total of 470 patients were included in the second meta-analysis: mean percentage of rebleeding in H. pylori Eradication Therapy group was 1.6%, and in non-Eradication Therapy group with long-term maintenance antisecretory Therapy it was 5.6% (OR 0.25, 95% CI 0.08 to 0.76; heterogeneity was not demonstrated; NNT was 20, 95% CI 12 to 100). Subanalysis. Excluding patients taking non-steroidal anti-inflammatory drugs (NSAIDs) at the time of recurrent bleeding resulted in a rebleeding rate of 4% (first meta-analysis) or 0.78% (second meta-analysis) in the group receiving H. pylori Eradication Therapy. When only patients with H. pylori Eradication success were included, rebleeding rate was 1% in H. pylori Eradication Therapy group, and NNT decreased from 5 to 4. In some cases, recurrence of H. pylori infection seemed to be responsible for recurrence of bleeding. Treatment of H. pylori infection is more effective than antisecretory non-eradicating Therapy (with or without long-term maintenance antisecretory Therapy) in preventing recurrent bleeding from peptic ulcer. Consequently, all patients with peptic ulcer bleeding should be tested for H. pylori infection, and Eradication Therapy should be prescribed to H. pylori-positive patients.
Xavier Calvet - One of the best experts on this subject based on the ideXlab platform.
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helicobacter pylori Eradication Therapy vs antisecretory non Eradication Therapy with or without long term maintenance antisecretory Therapy for the prevention of recurrent bleeding from peptic ulcer
Cochrane Database of Systematic Reviews, 2004Co-Authors: Javier P Gisbert, Sam Khorrami, Fernando Carballo, Xavier Calvet, Emili Gene, Enrique DominguezmunozAbstract:Background Peptic ulcer is the main cause for upper gastrointestinal haemorrhage, and Helicobacter pylori (H.pylori) infection is the main etiologic factor for peptic ulcer disease. Maintenance antisecretory Therapy is the standard long-term treatment for patients with bleeding ulcers to prevent recurrent bleeding. The efficacy of H. pylori Eradication for the prevention of rebleeding from peptic ulcer is unknown. Objectives To compare the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. Search methods We searched the Cochrane Controlled Trials Register (the Cochrane Library issue 4, 2003), MEDLINE (January 1966 to January 2004), EMBASE (January 1988 to January 2004), CINAHL (January 1982 to January 2004), and reference lists of articles. We also conducted a manual search from several congresses. The search strategy was re-run in January 2005 and October 2008, but no new trials were found. Selection criteria Controlled clinical trials comparing the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. Data collection and analysis Data extraction and quality assessment of studies was done by two reviewers. Study authors were contacted for additional information. Main results Seven studies with a total of 578 patients were included in the first comparison: mean percentage of rebleeding in H. pylori Eradication Therapy group was 2.9%, and in the non-Eradication Therapy group without subsequent long-term maintenance antisecretory Therapy it was 20% (OR 0.17, 95% CI 0.10 to 0.32; there was no statistical evidence of heterogeneity; NNT was 7, 95% CI 5 to 11). Three studies with a total of 470 patients were included in the second comparison: mean percentage of rebleeding in H. pylori Eradication Therapy group was 1.6%, and in non-Eradication Therapy group with long-term maintenance antisecretory Therapy it was 5.6% (OR 0.24, 95% CI 0.09 to 0.67; heterogeneity was not demonstrated; NNT was 20, 95% CI 12 to 100). Subgroup analyses were carried out to examine the effect of NSAIDS and of excluding H.pylori Eradication failures from the analyses. Authors' conclusions Treatment of H. pylori infection is more effective than antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) in preventing recurrent bleeding from peptic ulcer. All patients with peptic ulcer bleeding should be tested for H. pylori infection, and Eradication Therapy should be prescribed to H. pylori-positive patients.
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The Cochrane Library - Helicobacter pylori Eradication Therapy vs. antisecretory non‐Eradication Therapy (with or without long‐term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer
Cochrane Database of Systematic Reviews, 2004Co-Authors: Javier P Gisbert, Sam Khorrami, Fernando Carballo, Xavier Calvet, Emili Gene, Enrique Dominguez-muñozAbstract:Background Peptic ulcer is the main cause for upper gastrointestinal haemorrhage, and Helicobacter pylori (H.pylori) infection is the main etiologic factor for peptic ulcer disease. Maintenance antisecretory Therapy is the standard long-term treatment for patients with bleeding ulcers to prevent recurrent bleeding. The efficacy of H. pylori Eradication for the prevention of rebleeding from peptic ulcer is unknown. Objectives To compare the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. Search methods We searched the Cochrane Controlled Trials Register (the Cochrane Library issue 4, 2003), MEDLINE (January 1966 to January 2004), EMBASE (January 1988 to January 2004), CINAHL (January 1982 to January 2004), and reference lists of articles. We also conducted a manual search from several congresses. The search strategy was re-run in January 2005 and October 2008, but no new trials were found. Selection criteria Controlled clinical trials comparing the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. Data collection and analysis Data extraction and quality assessment of studies was done by two reviewers. Study authors were contacted for additional information. Main results Seven studies with a total of 578 patients were included in the first comparison: mean percentage of rebleeding in H. pylori Eradication Therapy group was 2.9%, and in the non-Eradication Therapy group without subsequent long-term maintenance antisecretory Therapy it was 20% (OR 0.17, 95% CI 0.10 to 0.32; there was no statistical evidence of heterogeneity; NNT was 7, 95% CI 5 to 11). Three studies with a total of 470 patients were included in the second comparison: mean percentage of rebleeding in H. pylori Eradication Therapy group was 1.6%, and in non-Eradication Therapy group with long-term maintenance antisecretory Therapy it was 5.6% (OR 0.24, 95% CI 0.09 to 0.67; heterogeneity was not demonstrated; NNT was 20, 95% CI 12 to 100). Subgroup analyses were carried out to examine the effect of NSAIDS and of excluding H.pylori Eradication failures from the analyses. Authors' conclusions Treatment of H. pylori infection is more effective than antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) in preventing recurrent bleeding from peptic ulcer. All patients with peptic ulcer bleeding should be tested for H. pylori infection, and Eradication Therapy should be prescribed to H. pylori-positive patients.
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meta analysis helicobacter pylori Eradication Therapy vs antisecretory non Eradication Therapy for the prevention of recurrent bleeding from peptic ulcer
Alimentary Pharmacology & Therapeutics, 2004Co-Authors: Javier P Gisbert, Sam Khorrami, Fernando Carballo, Xavier Calvet, Emili Gene, Enrique DominguezmunozAbstract:Summary Aim : To perform a meta-analysis comparing the efficacy of Helicobacter pylori Eradication Therapy vs. antisecretory non-Eradication Therapy for the prevention of recurrent bleeding from peptic ulcer. Methods : A search was made of the Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL and several congresses for controlled clinical trials comparing the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy for the prevention of peptic ulcer re-bleeding. Studies with all patients taking non-steroidal anti-inflammatory drugs were excluded. Extraction and quality assessment of the studies were performed by two reviewers. Results : In the first meta-analysis, the mean percentage of re-bleeding in the H. pylori Eradication Therapy group was 4.5%, compared with 23.7% in the non-Eradication Therapy group without long-term antisecretory Therapy [odds ratio, 0.18; 95% confidence interval (CI), 0.09–0.37; ‘number needed to treat’ (NNT), 5; 95% CI, 4–8]. In the second meta-analysis, the re-bleeding rate in the H. pylori Eradication Therapy group was 1.6%, compared with 5.6% in the non-Eradication Therapy group with maintenance antisecretory Therapy (odds ratio, 0.25; 95% CI, 0.08–0.76; NNT, 20; 95% CI, 12–100). When only patients with successful H. pylori Eradication were included, the re-bleeding rate was 1%. Conclusions : The treatment of H. pylori infection is more effective than antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory treatment) in the prevention of recurrent bleeding from peptic ulcer. Consequently, all patients with peptic ulcer bleeding should be tested for H. pylori, and Eradication Therapy should be prescribed to infected patients.
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H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer.
The Cochrane database of systematic reviews, 2003Co-Authors: Javier P Gisbert, Sam Khorrami, Fernando Carballo, Xavier Calvet, Emili Gene, J E Dominguez-muñozAbstract:Peptic ulcer is the main cause for upper gastrointestinal haemorrhage, and Helicobacter pylori infection is the main etiologic factor for peptic ulcer disease. Maintenance antisecretory Therapy has been the standard long-term treatment for patients with bleeding ulcers to prevent recurrent bleeding. On the other hand, the precise efficacy of H. pylori Eradication for the prevention of rebleeding from peptic ulcer is unknown. To compare the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. We searched the Cochrane Controlled Trials Register (the Cochrane Library issue 1, 2003), MEDLINE (January 1966 to March 2003), EMBASE (January 1988 to March 2003), CINAHL (January 1982 to March 2003), and reference lists of articles. We also conducted a manual search from several congresses. Controlled clinical trials comparing the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. Extraction and quality assessment of studies were done by two reviewers. Study authors were contacted for additional information. Six studies with a total of 355 patients were included in the first meta-analysis: mean percentage of rebleeding in H. pylori Eradication Therapy group was 4.5%, and in the non-Eradication Therapy group without subsequent long-term maintenance antisecretory Therapy it was 23.7% (OR 0.18, 95% CI 0.09 to 0.37; there was no statistical evidence of heterogeneity; NNT was 5, 95% CI 4 to 8). Three studies with a total of 470 patients were included in the second meta-analysis: mean percentage of rebleeding in H. pylori Eradication Therapy group was 1.6%, and in non-Eradication Therapy group with long-term maintenance antisecretory Therapy it was 5.6% (OR 0.25, 95% CI 0.08 to 0.76; heterogeneity was not demonstrated; NNT was 20, 95% CI 12 to 100). Subanalysis. Excluding patients taking non-steroidal anti-inflammatory drugs (NSAIDs) at the time of recurrent bleeding resulted in a rebleeding rate of 4% (first meta-analysis) or 0.78% (second meta-analysis) in the group receiving H. pylori Eradication Therapy. When only patients with H. pylori Eradication success were included, rebleeding rate was 1% in H. pylori Eradication Therapy group, and NNT decreased from 5 to 4. In some cases, recurrence of H. pylori infection seemed to be responsible for recurrence of bleeding. Treatment of H. pylori infection is more effective than antisecretory non-eradicating Therapy (with or without long-term maintenance antisecretory Therapy) in preventing recurrent bleeding from peptic ulcer. Consequently, all patients with peptic ulcer bleeding should be tested for H. pylori infection, and Eradication Therapy should be prescribed to H. pylori-positive patients.
Emili Gene - One of the best experts on this subject based on the ideXlab platform.
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helicobacter pylori Eradication Therapy vs antisecretory non Eradication Therapy with or without long term maintenance antisecretory Therapy for the prevention of recurrent bleeding from peptic ulcer
Cochrane Database of Systematic Reviews, 2004Co-Authors: Javier P Gisbert, Sam Khorrami, Fernando Carballo, Xavier Calvet, Emili Gene, Enrique DominguezmunozAbstract:Background Peptic ulcer is the main cause for upper gastrointestinal haemorrhage, and Helicobacter pylori (H.pylori) infection is the main etiologic factor for peptic ulcer disease. Maintenance antisecretory Therapy is the standard long-term treatment for patients with bleeding ulcers to prevent recurrent bleeding. The efficacy of H. pylori Eradication for the prevention of rebleeding from peptic ulcer is unknown. Objectives To compare the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. Search methods We searched the Cochrane Controlled Trials Register (the Cochrane Library issue 4, 2003), MEDLINE (January 1966 to January 2004), EMBASE (January 1988 to January 2004), CINAHL (January 1982 to January 2004), and reference lists of articles. We also conducted a manual search from several congresses. The search strategy was re-run in January 2005 and October 2008, but no new trials were found. Selection criteria Controlled clinical trials comparing the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. Data collection and analysis Data extraction and quality assessment of studies was done by two reviewers. Study authors were contacted for additional information. Main results Seven studies with a total of 578 patients were included in the first comparison: mean percentage of rebleeding in H. pylori Eradication Therapy group was 2.9%, and in the non-Eradication Therapy group without subsequent long-term maintenance antisecretory Therapy it was 20% (OR 0.17, 95% CI 0.10 to 0.32; there was no statistical evidence of heterogeneity; NNT was 7, 95% CI 5 to 11). Three studies with a total of 470 patients were included in the second comparison: mean percentage of rebleeding in H. pylori Eradication Therapy group was 1.6%, and in non-Eradication Therapy group with long-term maintenance antisecretory Therapy it was 5.6% (OR 0.24, 95% CI 0.09 to 0.67; heterogeneity was not demonstrated; NNT was 20, 95% CI 12 to 100). Subgroup analyses were carried out to examine the effect of NSAIDS and of excluding H.pylori Eradication failures from the analyses. Authors' conclusions Treatment of H. pylori infection is more effective than antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) in preventing recurrent bleeding from peptic ulcer. All patients with peptic ulcer bleeding should be tested for H. pylori infection, and Eradication Therapy should be prescribed to H. pylori-positive patients.
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The Cochrane Library - Helicobacter pylori Eradication Therapy vs. antisecretory non‐Eradication Therapy (with or without long‐term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer
Cochrane Database of Systematic Reviews, 2004Co-Authors: Javier P Gisbert, Sam Khorrami, Fernando Carballo, Xavier Calvet, Emili Gene, Enrique Dominguez-muñozAbstract:Background Peptic ulcer is the main cause for upper gastrointestinal haemorrhage, and Helicobacter pylori (H.pylori) infection is the main etiologic factor for peptic ulcer disease. Maintenance antisecretory Therapy is the standard long-term treatment for patients with bleeding ulcers to prevent recurrent bleeding. The efficacy of H. pylori Eradication for the prevention of rebleeding from peptic ulcer is unknown. Objectives To compare the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. Search methods We searched the Cochrane Controlled Trials Register (the Cochrane Library issue 4, 2003), MEDLINE (January 1966 to January 2004), EMBASE (January 1988 to January 2004), CINAHL (January 1982 to January 2004), and reference lists of articles. We also conducted a manual search from several congresses. The search strategy was re-run in January 2005 and October 2008, but no new trials were found. Selection criteria Controlled clinical trials comparing the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. Data collection and analysis Data extraction and quality assessment of studies was done by two reviewers. Study authors were contacted for additional information. Main results Seven studies with a total of 578 patients were included in the first comparison: mean percentage of rebleeding in H. pylori Eradication Therapy group was 2.9%, and in the non-Eradication Therapy group without subsequent long-term maintenance antisecretory Therapy it was 20% (OR 0.17, 95% CI 0.10 to 0.32; there was no statistical evidence of heterogeneity; NNT was 7, 95% CI 5 to 11). Three studies with a total of 470 patients were included in the second comparison: mean percentage of rebleeding in H. pylori Eradication Therapy group was 1.6%, and in non-Eradication Therapy group with long-term maintenance antisecretory Therapy it was 5.6% (OR 0.24, 95% CI 0.09 to 0.67; heterogeneity was not demonstrated; NNT was 20, 95% CI 12 to 100). Subgroup analyses were carried out to examine the effect of NSAIDS and of excluding H.pylori Eradication failures from the analyses. Authors' conclusions Treatment of H. pylori infection is more effective than antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) in preventing recurrent bleeding from peptic ulcer. All patients with peptic ulcer bleeding should be tested for H. pylori infection, and Eradication Therapy should be prescribed to H. pylori-positive patients.
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meta analysis helicobacter pylori Eradication Therapy vs antisecretory non Eradication Therapy for the prevention of recurrent bleeding from peptic ulcer
Alimentary Pharmacology & Therapeutics, 2004Co-Authors: Javier P Gisbert, Sam Khorrami, Fernando Carballo, Xavier Calvet, Emili Gene, Enrique DominguezmunozAbstract:Summary Aim : To perform a meta-analysis comparing the efficacy of Helicobacter pylori Eradication Therapy vs. antisecretory non-Eradication Therapy for the prevention of recurrent bleeding from peptic ulcer. Methods : A search was made of the Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL and several congresses for controlled clinical trials comparing the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy for the prevention of peptic ulcer re-bleeding. Studies with all patients taking non-steroidal anti-inflammatory drugs were excluded. Extraction and quality assessment of the studies were performed by two reviewers. Results : In the first meta-analysis, the mean percentage of re-bleeding in the H. pylori Eradication Therapy group was 4.5%, compared with 23.7% in the non-Eradication Therapy group without long-term antisecretory Therapy [odds ratio, 0.18; 95% confidence interval (CI), 0.09–0.37; ‘number needed to treat’ (NNT), 5; 95% CI, 4–8]. In the second meta-analysis, the re-bleeding rate in the H. pylori Eradication Therapy group was 1.6%, compared with 5.6% in the non-Eradication Therapy group with maintenance antisecretory Therapy (odds ratio, 0.25; 95% CI, 0.08–0.76; NNT, 20; 95% CI, 12–100). When only patients with successful H. pylori Eradication were included, the re-bleeding rate was 1%. Conclusions : The treatment of H. pylori infection is more effective than antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory treatment) in the prevention of recurrent bleeding from peptic ulcer. Consequently, all patients with peptic ulcer bleeding should be tested for H. pylori, and Eradication Therapy should be prescribed to infected patients.
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H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer.
The Cochrane database of systematic reviews, 2003Co-Authors: Javier P Gisbert, Sam Khorrami, Fernando Carballo, Xavier Calvet, Emili Gene, J E Dominguez-muñozAbstract:Peptic ulcer is the main cause for upper gastrointestinal haemorrhage, and Helicobacter pylori infection is the main etiologic factor for peptic ulcer disease. Maintenance antisecretory Therapy has been the standard long-term treatment for patients with bleeding ulcers to prevent recurrent bleeding. On the other hand, the precise efficacy of H. pylori Eradication for the prevention of rebleeding from peptic ulcer is unknown. To compare the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. We searched the Cochrane Controlled Trials Register (the Cochrane Library issue 1, 2003), MEDLINE (January 1966 to March 2003), EMBASE (January 1988 to March 2003), CINAHL (January 1982 to March 2003), and reference lists of articles. We also conducted a manual search from several congresses. Controlled clinical trials comparing the efficacy of H. pylori Eradication Therapy vs. antisecretory non-Eradication Therapy (with or without long-term maintenance antisecretory Therapy) for the prevention of recurrent bleeding from peptic ulcer. Extraction and quality assessment of studies were done by two reviewers. Study authors were contacted for additional information. Six studies with a total of 355 patients were included in the first meta-analysis: mean percentage of rebleeding in H. pylori Eradication Therapy group was 4.5%, and in the non-Eradication Therapy group without subsequent long-term maintenance antisecretory Therapy it was 23.7% (OR 0.18, 95% CI 0.09 to 0.37; there was no statistical evidence of heterogeneity; NNT was 5, 95% CI 4 to 8). Three studies with a total of 470 patients were included in the second meta-analysis: mean percentage of rebleeding in H. pylori Eradication Therapy group was 1.6%, and in non-Eradication Therapy group with long-term maintenance antisecretory Therapy it was 5.6% (OR 0.25, 95% CI 0.08 to 0.76; heterogeneity was not demonstrated; NNT was 20, 95% CI 12 to 100). Subanalysis. Excluding patients taking non-steroidal anti-inflammatory drugs (NSAIDs) at the time of recurrent bleeding resulted in a rebleeding rate of 4% (first meta-analysis) or 0.78% (second meta-analysis) in the group receiving H. pylori Eradication Therapy. When only patients with H. pylori Eradication success were included, rebleeding rate was 1% in H. pylori Eradication Therapy group, and NNT decreased from 5 to 4. In some cases, recurrence of H. pylori infection seemed to be responsible for recurrence of bleeding. Treatment of H. pylori infection is more effective than antisecretory non-eradicating Therapy (with or without long-term maintenance antisecretory Therapy) in preventing recurrent bleeding from peptic ulcer. Consequently, all patients with peptic ulcer bleeding should be tested for H. pylori infection, and Eradication Therapy should be prescribed to H. pylori-positive patients.