Ten RCTs were initially identified as being relevant. However, only the seven trials (n=470) that were published as full peer-reviewed publications were included in the meta-analysis.
Treatment of H. pylori infection compared with ulcer healing treatment alone.
Four (n=262) of the 7 trials compared treatment of H. pylori infection with ulcer healing treatment alone. Three trials were restricted to patients with duodenal ulcers haemorrhage, whilst one included patients with either gastric or duodenal ulcer haemorrhage. There was no significant heterogeneity between the trials (p=0.36), so they were combined in the meta analysis.
The pooled RRR for recurrent bleeding was 79%, with a range of 50 to 100% for the individual trials. The pooled ARR was 17% (95% CI: 9, 25) and the NNT in order to prevent one recurrent ulcer haemorrhage was 6 (95% CI: 4, 11).
Three of the 4 trials reported rates of recurrent ulcer with pain but without bleeding (RRR 85%, 95% CI: 69, 94; ARR 25%, 95% CI: 16, 34); the NNT to prevent one painful recurrence was 4 (95% CI: 3, 6). All treated patients who developed recurrent ulcer with pain, but without bleeding, showed evidence that eradication of H. pylori infection had failed.
For recurrent ulcer with bleeding or pain, the pooled RRR was 81% (range: 75 to 88), the ARR was 41% (95% CI: 30, 52), and the NNT was 2 (95% CI: 2, 3).
Treatment of H. pylori infection compared with initial ulcer healing treatment followed by maintenance therapy.
This comparison was made in 3 (n=470) of the 7 included trials; there was no significant heterogeneity between these trials (p=0.81).
The pooled RRR for recurrent bleeding was 72%, with a range of 49 to 100% for the individual trials. The ARR was 4.1% (95% CI: 0.6, 7.5) and the NNT was 25 (95% CI: 13, 167).
The pooled RRR for ulcer recurrence with pain but no bleeding was 79% (range: 76, 100), the ARR was 7.4% (95% CI: 3, 12), and the NNT was 13 (95% CI: 8, 33).
For recurrent ulcer with bleeding or pain, the pooled RRR was 77% (range: 77, 89), the ARR was 12% (95% CI: 6, 17), and the NNT was 9 (95% CI: 6, 17).