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Helicobacter pylori Therapy Demystified

2011; Wiley; Volume: 16; Issue: 5 Linguagem: Inglês

10.1111/j.1523-5378.2011.00891.x

1523-5378

David Y. Graham, Maria Pina Dore,

Microscopic Colitis

HelicobacterVolume 16, Issue 5 p. 343-345 EDITORIAL Helicobacter pylori Therapy Demystified David Y. Graham, David Y. Graham Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USASearch for more papers by this authorMaria P. Dore, Maria P. Dore Istituto di Clinica Medica, University of Sassari, Sassari, ItalySearch for more papers by this author David Y. Graham, David Y. Graham Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USASearch for more papers by this authorMaria P. Dore, Maria P. Dore Istituto di Clinica Medica, University of Sassari, Sassari, ItalySearch for more papers by this author First published: 19 September 2011 https://doi.org/10.1111/j.1523-5378.2011.00891.xCitations: 17 Reprint requests to: David Y. Graham, Department of Medicine (111D), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA. E-mail: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Abstract We discuss the role of comparators in Helicobacter pylori treatment trials and why anti-H. pylori therapeutic trials (an infectious disease) are fundamentally different from common gastrointestinal diseases (e.g., the absence of a placebo response, the expectation that cure rates in excess of 95%, and the ability to understand why treatment fails). No comparator is absolutely required other than to 100% success and comparison trials should be limited to comparisons between therapies that reliably achieve 90% or greater success (i.e., good therapies). Comparisons with known low success regimens (i.e., bad therapies) are unethical as is withholding information from the subject regarding current effectiveness of a regimen even if that information would reduce the likelihood that the subject would volunteer. We also discuss how it is possible to predict the outcome of a published but locally untried new regimen. The reason for different outcomes of typical gastrointestinal therapies is shrouded in mystery. In contrast, treatment success for H. pylori should be predictable and treatment failures explainable. For too long expectations and analyses of H. pylori therapy has been confused with what is appropriate for gastrointestinal disease such as constipation or irritable bowel syndrome rather than for infectious diseases such as pneumonia. References 1 Calvet X, Gisbert JP, Suarez D. Key points for designing and reporting H. pylori therapeutic trials. A personal view. Helicobacter 2011; 5: 346–55. 2 Graham DY. Helicobacter pylori eradication therapy research: ethical issues and description of results. Clin Gastroenterol Hepatol 2010; 8: 1032–6. 3 Graham DY, Rimbara E. Understanding and appreciating sequential therapy for Helicobacter pylori eradication. J Clin Gastroenterol 2011; 45: 309–13. 4 Graham DY. Efficient identification and evaluation of effective Helicobacter pylori therapies. Clin Gastroenterol Hepatol 2009; 7: 145–8. 5 Graham DY, Lu H, Yamaoka Y. A report card to grade Helicobacter pylori therapy. Helicobacter 2007; 12: 275–8. Citing Literature Volume16, Issue5October 2011Pages 343-345 ReferencesRelatedInformation