Review
Smoking Increases the Treatment Failure for Helicobacter pylori Eradication

https://doi.org/10.1016/j.amjmed.2005.10.003Get rights and content

Abstract

Purpose

Treatment failure for Helicobacter pylori (H. pylori) eradication is encountered in approximately 10-20% of patients, and many studies have pointed to a link with smoking. To investigate the effects of smoking on eradication outcome, we performed a meta-analysis.

Methods

A PubMed search was performed to retrieve articles published up to August 2005. Pooled odds ratio (OR) and differences rate for H. pylori eradication failure in smokers compared with nonsmokers were used as summary statistics. Meta-regression was used for examining the source of heterogeneity.

Results

Twenty-two published studies (5538 patients), which provided information on eradication failure according to smoking status, were included in the analysis. The summary OR for eradication failure among smokers relative to nonsmokers was 1.95 (95% confidence interval [CI]: 1.55-2.45; P <.01). It corresponds with the differences in eradication rates between smokers and nonsmokers (8.4% [95% CI: 3.3-13.5%, P <.01]). Meta-regression analysis demonstrated that a high proportion of nonulcer dyspepsia patients in studies revealed a higher failure rate among smokers, compared with a low proportion of nonulcer dyspepsia.

Conclusions

Our meta-analysis demonstrated that smoking increases the treatment failure rate for H. pylori eradication.

Section snippets

Selection of Studies

The initial literature search was conducted through PubMed by using the free text search term: (helicobacter pylori) AND (smoking OR smoker OR tobacco) AND (eradication), with the publication period limited up to August 2005. The inclusion criteria for our analysis were: 1) original articles published in English; 2) odds ratios (ORs) available as a measure of association or the number of succeeded and failed cases according to the smoking category; 3) use of the urea breath test or histological

Description of the Studies

The search yielded a total of 134 publications, 36 of which were excluded by screening of their titles. Abstracts of the remaining 98 articles were reviewed, and 59 were retrieved in full for further consideration. We examined all the candidate articles in detail, which resulted in further exclusion of 37 articles. They were excluded because 1) data for ORs or the number of eradication cases according to the smoking category could not be obtained (n = 26); 2) therapies were second line (n = 4);

Discussion

This study shows that smoking increases risk of treatment failure for H. pylori eradication. We also found significant low rate of eradication among smokers. Of 22 studies we selected to examine, 12 studies observed a significant increase in ORs for eradication failure in smokers. Of 13 studies in which we could gain information about difference rate of eradication according to smoking category, 11 studies observed a higher rate of eradication failure in smokers compared with nonsmokers. The

References (51)

  • K. Endoh et al.

    Effects of smoking and nicotine on the gastric mucosaa review of clinical and experimental evidence

    Gastroenterology

    (1994)
  • J. Parsonnet et al.

    Helicobacter pylori infection and the risk of gastric carcinoma

    N Engl J Med

    (1991)
  • J.P. Gisbert et al.

    Systematic review and meta-analysisproton pump inhibitor vs. ranitidine bismuth citrate plus two antibiotics in Helicobacter pylori eradication

    Helicobacter

    (2005)
  • N. Broutet et al.

    Risk factors for failure of Helicobacter pylori therapy—results of an individual data analysis of 2751 patients

    Aliment Pharmacol Ther

    (2003)
  • C.K. Lin et al.

    One-week quadruple therapy is an effective salvage regimen for Helicobacter pylori infection in patients after failure of standard triple therapy

    J Clin Gastroenterol

    (2002)
  • L.J. van Doorn et al.

    Importance of Helicobacter pylori cagA and vacA status for the efficacy of antibiotic treatment

    Gut

    (2000)
  • N. Broutet et al.

    cagA Status and eradication treatment outcome of anti-Helicobacter pylori triple therapies in patients with nonulcer dyspepsia

    J Clin Microbiol

    (2001)
  • P. Moayyedi et al.

    Patient factors that predict failure of omeprazole, clarithromycin, and tinidazole to eradicate Helicobacter pylori

    J Gastroenterol

    (1997)
  • T. Kamada et al.

    Effect of smoking and histological gastritis severity on the rate of H. pylori eradication with omeprazole, amoxicillin, and clarithromycin

    Helicobacter

    (1999)
  • F. Perri et al.

    Predictors of failure of Helicobacter pylori eradication with the standard ‘Maastricht triple therapy’

    Aliment Pharmacol Ther

    (2001)
  • G. Treiber et al.

    Clinical outcome and influencing factors of a new short-term quadruple therapy for Helicobacter pylori eradicationa randomized controlled trial (MACLOR study)

    Arch Intern Med

    (2002)
  • S.B. Lee et al.

    Efficacy of triple therapy with rabeprazole for Helicobacter pylori infection in relation to CYP2C19 genotype

    Korean J Gastroenterol

    (2003)
  • M.J. Janssen et al.

    The influence of pretreatment on cure rates of Helicobacter pylori eradication

    Neth J Med

    (2004)
  • T.T. Koivisto et al.

    First-line eradication therapy for Helicobacter pylori in primary health care based on antibiotic resistanceresults of three eradication regimens

    Aliment Pharmacol Ther

    (2005)
  • G. Manes et al.

    Twice-daily standard dose of omeprazole achieves the necessary level of acid inhibition for Helicobacter pylori eradication. A randomized controlled trial using standard and double doses of omeprazole in triple therapy

    Dig Dis Sci

    (2005)
  • Cited by (0)

    This work was supported in part by a Grant-in-Aid for Cancer Research (17-1) from the Ministry of Health, Labour and Welfare, Tokyo, Japan.

    View full text