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Article: Effect of Helicobacter pylori eradication on treatment of gastro-oesophageal reflux disease: A double blind, placebo controlled, randomised trial

TitleEffect of Helicobacter pylori eradication on treatment of gastro-oesophageal reflux disease: A double blind, placebo controlled, randomised trial
Authors
Issue Date2004
PublisherBMJ Publishing Group. The Journal's web site is located at http://gut.bmjjournals.com/
Citation
Gut, 2004, v. 53 n. 2, p. 174-179 How to Cite?
AbstractBackground: The role of Helicobacter pylori eradication in the management of gastro-oesophageal reflux disease (GORD) is controversial. We hypothesised that H pylori eradication leads to worsened control of reflux disease. Methods: Consecutive patients with weekly reflux symptoms were prospectively recruited for endoscopy and symptom evaluation. Patients were enrolled if they had H pylori infection and required long term acid suppressants. Eligible patients were randomly assigned to omeprazole triple therapy (HpE group) or omeprazole with placebo antibiotics (Hp+ group) for one week. Omeprazole 20 mg daily was given for eight weeks for healing of oesophagitis and symptom relief. This was followed by a maintenance dose of 10 mg daily for up to 12 months. The primary study end point was the probability of treatment failure within 12 months, which was defined as either incomplete resolution of symptoms or oesophagitis at the initial treatment phase, or relapse of symptoms and oesophagitis during the maintenance phase. Predictors of treatment failure were determined by Cox's proportional hazards model. Results: A total of 236 GORD patients were screened and 113 (47.9%) were positive for H pylori; 104 (92%) patients were included in the intention to treat analysis (53 in the HpE group and 51 in the Hp+ group). Thirty one patients (30%) had erosive oesophagitis at baseline. H pylori was eradicated in 98% of the HpE group and in 3.9% of the Hp+ group. Overall, 15 patients (28.3%) in the HpE group and eight patients (15.7%) in the Hp+ group had treatment failure. The 12 month probability of treatment failure was 43.2% (95% confidence interval (CI) 29.9-56.5%) in the HpE group and 21.1% (95% CI 9.9-32.3%) in the Hp+ group (log rank test, p = 0.043). In the Cox proportional hazards model, after adjustment for the covariates age, sex, erosive oesophagitis, hiatus hernia, degree of gastritis, and severity of symptoms at baseline, H pylori eradication was the only predictor of treatment failure (adjusted hazard ratio 2.47 (95% CI 1.05-5.85)). Conclusion: H pylori eradication leads to more resilient GORD.
Persistent Identifierhttp://hdl.handle.net/10722/162816
ISSN
2015 Impact Factor: 14.921
2015 SCImago Journal Rankings: 6.474
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorWu, JCYen_US
dc.contributor.authorChan, FKLen_US
dc.contributor.authorChing, JYLen_US
dc.contributor.authorLeung, WKen_US
dc.contributor.authorHui, Yen_US
dc.contributor.authorLeong, Ren_US
dc.contributor.authorChung, SCSen_US
dc.contributor.authorSung, JJYen_US
dc.date.accessioned2012-09-05T05:23:53Z-
dc.date.available2012-09-05T05:23:53Z-
dc.date.issued2004en_US
dc.identifier.citationGut, 2004, v. 53 n. 2, p. 174-179en_US
dc.identifier.issn0017-5749en_US
dc.identifier.urihttp://hdl.handle.net/10722/162816-
dc.description.abstractBackground: The role of Helicobacter pylori eradication in the management of gastro-oesophageal reflux disease (GORD) is controversial. We hypothesised that H pylori eradication leads to worsened control of reflux disease. Methods: Consecutive patients with weekly reflux symptoms were prospectively recruited for endoscopy and symptom evaluation. Patients were enrolled if they had H pylori infection and required long term acid suppressants. Eligible patients were randomly assigned to omeprazole triple therapy (HpE group) or omeprazole with placebo antibiotics (Hp+ group) for one week. Omeprazole 20 mg daily was given for eight weeks for healing of oesophagitis and symptom relief. This was followed by a maintenance dose of 10 mg daily for up to 12 months. The primary study end point was the probability of treatment failure within 12 months, which was defined as either incomplete resolution of symptoms or oesophagitis at the initial treatment phase, or relapse of symptoms and oesophagitis during the maintenance phase. Predictors of treatment failure were determined by Cox's proportional hazards model. Results: A total of 236 GORD patients were screened and 113 (47.9%) were positive for H pylori; 104 (92%) patients were included in the intention to treat analysis (53 in the HpE group and 51 in the Hp+ group). Thirty one patients (30%) had erosive oesophagitis at baseline. H pylori was eradicated in 98% of the HpE group and in 3.9% of the Hp+ group. Overall, 15 patients (28.3%) in the HpE group and eight patients (15.7%) in the Hp+ group had treatment failure. The 12 month probability of treatment failure was 43.2% (95% confidence interval (CI) 29.9-56.5%) in the HpE group and 21.1% (95% CI 9.9-32.3%) in the Hp+ group (log rank test, p = 0.043). In the Cox proportional hazards model, after adjustment for the covariates age, sex, erosive oesophagitis, hiatus hernia, degree of gastritis, and severity of symptoms at baseline, H pylori eradication was the only predictor of treatment failure (adjusted hazard ratio 2.47 (95% CI 1.05-5.85)). Conclusion: H pylori eradication leads to more resilient GORD.en_US
dc.languageengen_US
dc.publisherBMJ Publishing Group. The Journal's web site is located at http://gut.bmjjournals.com/en_US
dc.relation.ispartofGuten_US
dc.subject.meshAgeden_US
dc.subject.meshAmoxicillin - Therapeutic Useen_US
dc.subject.meshAnti-Ulcer Agents - Therapeutic Useen_US
dc.subject.meshChi-Square Distributionen_US
dc.subject.meshClarithromycin - Therapeutic Useen_US
dc.subject.meshDouble-Blind Methoden_US
dc.subject.meshDrug Therapy, Combination - Therapeutic Useen_US
dc.subject.meshFemaleen_US
dc.subject.meshGastric Mucosa - Pathologyen_US
dc.subject.meshGastroesophageal Reflux - Drug Therapy - Pathologyen_US
dc.subject.meshHelicobacter Infections - Drug Therapy - Pathologyen_US
dc.subject.meshHelicobacter Pylorien_US
dc.subject.meshHumansen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshOmeprazole - Therapeutic Useen_US
dc.subject.meshProportional Hazards Modelsen_US
dc.subject.meshStatistics, Nonparametricen_US
dc.subject.meshTreatment Failureen_US
dc.titleEffect of Helicobacter pylori eradication on treatment of gastro-oesophageal reflux disease: A double blind, placebo controlled, randomised trialen_US
dc.typeArticleen_US
dc.identifier.emailLeung, WK:waikleung@hku.hken_US
dc.identifier.authorityLeung, WK=rp01479en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1136/gut.2003.012641en_US
dc.identifier.pmid14724146-
dc.identifier.scopuseid_2-s2.0-1642492959en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-1642492959&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume53en_US
dc.identifier.issue2en_US
dc.identifier.spage174en_US
dc.identifier.epage179en_US
dc.identifier.isiWOS:000188098100006-
dc.publisher.placeUnited Kingdomen_US
dc.identifier.scopusauthoridWu, JCY=7409253910en_US
dc.identifier.scopusauthoridChan, FKL=7202586434en_US
dc.identifier.scopusauthoridChing, JYL=7005086238en_US
dc.identifier.scopusauthoridLeung, WK=7201504523en_US
dc.identifier.scopusauthoridHui, Y=7103107510en_US
dc.identifier.scopusauthoridLeong, R=24343912800en_US
dc.identifier.scopusauthoridChung, SCS=19642462800en_US
dc.identifier.scopusauthoridSung, JJY=35405352400en_US

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