For what conditions is there evidence-based justification for treatment of Helicobacter pylori infection?

Research output: Contribution to journalArticle

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Abstract

Evidence-based medicine combines clinical expertise and the best available evidence from systematic research to aid decision making in patient care. Levels of evidence can be graded from I to V, with level I, the strongest, coming from large randomized controlled trials (RCTs). When a definitive RCT has not been performed, or is impracticable or inappropriate, lesser grades of evidence are used. There is level I evidence supporting the treatment of Helicobacter pylori infection in patients with duodenal or gastric ulcers. Prospective RCTs have shown that cure of the infection is associated with ultimate cure of the ulcer diathesis. Therefore, this is a 'grade A' recommendation for treatment. In nonulcer dyspepsia, numerous RCTs have yielded conflicting results regarding the benefits of treatment. Although there are methodological problems with many reported studies, there is some evidence (level II at best) to support treatment-a grade B recommendation. In early gastric cancer and gastric mucosa-associated lymphoid tissue lymphoma, the best available evidence supporting treatment of H. pylori infection is of low quality, i.e., levels III and V. Although these carry only grade C treatment recommendations, treatment is safe and carries at least some evidence of efficacy. It is therefore indicated based on the current best available evidence. No evidence exists to support treating the infection in patients receiving long-term proton pump inhibitors for gastroesophageal reflux disease or in patients with any of the nongastro- intestinal conditions that have been tentatively linked to H. pylori.

Original languageEnglish (US)
JournalGastroenterology
Volume113
Issue number6 SUPPL.
DOIs
StatePublished - Jan 1 1997
Externally publishedYes

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Helicobacter Infections
Helicobacter pylori
Randomized Controlled Trials
Therapeutics
Stomach Neoplasms
Marginal Zone B-Cell Lymphoma
Proton Pump Inhibitors
Dyspepsia
Evidence-Based Medicine
Disease Susceptibility
Stomach Ulcer
Duodenal Ulcer
Gastroesophageal Reflux
Gastric Mucosa
Infection
Ulcer
Decision Making
Patient Care
Research

All Science Journal Classification (ASJC) codes

  • Gastroenterology

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For what conditions is there evidence-based justification for treatment of Helicobacter pylori infection? / Howden, Colin.

In: Gastroenterology, Vol. 113, No. 6 SUPPL., 01.01.1997.

Research output: Contribution to journalArticle

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