Meta-analysisindependent cross-checkabstract only checked★ key study I-GUT-02 in-depth review
Treating H. pylori prevents ulcers returning (Cochrane)
Eradication therapy for peptic ulcer disease in Helicobacter pylori-positive people.
Overview
Ford AC et al.. Cochrane Database Syst Rev 2016 · PMID 27092708 · DOI 10.1002/14651858.CD003840.pub5
Duodenal ulcer recurrence fell from 64% without treatment to 13% with eradication.
Does the study support the specific claim? No · Methodological quality: high
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Ulcer treatment.
- How was the study done?
Cochrane review.
- How many people, animals or samples were studied?
Thousands.
- What was actually found?
Fewer recurrences.
- How large was the observed effect?
RR 0.20.
- What do the results mean in everyday life?
Eradication works.
- What are the study's limitations?
Older trials.
- What does it say about Elawady's specific claim?
Contradicts C-GUT-06.
- Do the results apply to Germany and Europe?
Applicable.
Scientific in-depth review
1. Full reference
- Authors
- Ford AC et al.
- Journal
- Cochrane Database Syst Rev
- Year
- 2016
- Identifier
- PMID 27092708 DOI 10.1002/14651858.CD003840.pub5
- Verification
- verified – PubMed efetch 2026-10-25
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Kurinchi Gurusamy: receives funding from the National Institute for Health Research to perform systematic reviews (Sources of support) and from Wellcome Trust UK and Cancer Research UK for unrelated projects. Alex Ford: none. Brendan Delaney: has received speaker's fees from Astra Zeneca and AxCan Pharma, holds grants from the MRC and NHS R&D programme and is supported by an NHS R&D Primary Care Career Scientist Award (No. CSA99/008). David Forman: has received speakers/consulting fees from AstraZeneca, Wyeth, and Takeda. Paul Moayyedi: chair at McMaster University partly funded by an unrestricted donation by AstraZeneca, and has received consultant's and speaker's bureau fees from AstraZeneca, AxCan Pharma, Nycomed, and Johnson & Johnson.
2. Research question
Eradication therapy for peptic ulcer in H. pylori-positive people
3. Study design and population
- Study design
- Meta-analysis – Cochrane systematic review and meta-analysis of RCTs
- Population
H. pylori-positive ulcer patients
- Country
Multinational
- Sample size
Many RCTs (e.g. 27 trials, 2,509 for duodenal recurrence)
- Inclusion and exclusion criteria
RCTs
4. Methods and endpoints
- Exposure / intervention
Eradication therapy
- Comparator
Ulcer healing drugs; no treatment
- Endpoints
Healing, recurrence
- Statistical methods
Pooled RR; GRADE
5. Actual results
- Results
Preventing duodenal ulcer recurrence vs no treatment: RR 0.20 (0.15–0.26), 12.9% vs 64.4% (very low quality); gastric ulcer recurrence RR 0.31 (0.22–0.45), 16.3% vs 52.4%; effective for duodenal ulcer healing vs ulcer-healing drugs alone.
- Absolute risks
Recurrence 12.9% vs 64.4% (duodenal)
- Authors' conclusion
Eradication is effective for H. pylori-positive duodenal ulcer and prevents recurrence of duodenal and gastric ulcers vs no treatment.
6. Strengths
- Cochrane
- Many RCTs
7. Weaknesses
- Low/very low GRADE for some outcomes (older trials)
8. Risk of bias
- Orienting tool
- AMSTAR 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- low
- Rationale
High-quality review; primary trial quality limited.
9. Assessment of the statistical interpretation
Large, consistent effects.
10. Relevance to the specific claim
11. Independent contrary findings
12. Transferability to Germany and Europe
High.
13. Overall methodological judgement
Strong evidence that H. pylori causes ulcer recurrence.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | high |
| Risk of bias | low |
| Precision of results | high |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
15. Linked fact checks
- Redefining peptic ulcer as an H. pylori infection was a 'crime'; the real problem is low stomach acid, and acid blockers plus antibiotic 'triple therapy' are the wrong treatment. – Studies contradicting or limiting the claim