Effect of population screening and treatment for Helicobacter pylori on dyspepsia and quality of life in the community: a randomised controlled trial

• Published in: The Lancet (British edition) Vol. 355; no. 9216; pp. 1665 - 1669
• Main Authors: Moayyedi, Paul, Feltbower, Richard, Brown, Julia, Mason, Su, Mason, James, Nathan, Jackie, Richards, ID Gerald, Dowell, Anthony C, Axon, Anthony TR
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 13-05-2000; Lancet; Elsevier Limited
• Subjects: Bacteria; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Biological and medical sciences; Clinical trials; Disease; Human bacterial diseases; Infections; Infectious diseases; Medical sciences; Medical screening; Quality of life; Human; Spirillales; Dyspepsia; Spirillaceae; Medical screening; Quality of life; Infection; Randomization; Helicobacter pylori; Bacteriosis; Digestive diseases; Bacteria; Influence; Anastomotic ulcer; Gastric disease
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(00)02236-4

Infection with
Helicobacter pylori is the main cause of peptic-ulcer disease. Treatment of this infection might lower the prevalence of dyspepsia in the community and improve quality of life. We investigated this possibility in a double-blind randomised controlled trial.
Individuals aged 40–49 years were randomly selected from the lists of 36 primary-care centres. A researcher interviewed participants with a validated dyspepsia questionnaire and the psychological general wellbeing index (PGWB).
H pylori status was assessed by the carbon-13-labelled urea breath test. Infected participants were randomly assigned active treatment (omeprazole 20 mg, clarithromycin 250 mg, and tinidazole 500 mg, each twice daily for 7 days) or identical placebo. Participants were followed up at 6 months and 2 years.
Of 32 929 individuals invited, 8455 attended and were eligible; 2324 were positive for
H pylori and were assigned active treatment (1161) or placebo (1163). 1773 (76%) returned at 2 years. Dyspepsia or symptoms of gastro-oesophageal reflux were reported in 247 (28%) of 880 in the treatment group and 291 (33%) of 871 in the placebo group (absolute-risk reduction 5% [95% CI 1–10]).
H pylori treatment had no significant effect on quality of life (mean difference in PGWB score between groups 0·86 [−0·33 to 2·05]).
Community screening and treatment for
H pylori produced only a 5% reduction in dyspepsia. This small benefit had no impact on quality of life.