Will Crocombe

The proportion of upper gastrointestinal symptoms in the community associated with helicobacter pylori , lifestyle factors, and nonsteroidal anti-inflammatory drugs

OBJECTIVE:Upper gastrointestinal disorders are common in the community, yet the determinants of these symptoms are poorly characterized. The association between upper gastrointestinal symptoms and Helicobacter pylori (H. pylori), socioeconomic status, nonsteroidal antiinflammatory drug (NSAID) use, smoking, alcohol, and coffee intake was assessed in a cross-sectional survey.METHODS:Subjects between the ages of 40–49 yr were randomly selected from the lists of 36 primary care centers. Participants attended their local primary care center and were interviewed by a researcher using a validated dyspepsia questionnaire. H. pylori status was determined by a nonfasting 13C-urea breath test.RESULTS:A total of 32,929 subjects were invited, and 8,407 (25%) attended and were eligible. Of these, 2,329 (28%) were H. pylori positive and 3,177 (38%) had dyspepsia. Also, 44% of H. pylori-infected participants reported dyspepsia compared with 36% of uninfected subjects [odds ratio = 1.39; 95% confidence interval (CI) 1.26–1.53]. H. pylori infection remained a significant risk factor for dyspepsia in a multiple logistic regression model (odds ratio = 1.21; 95% CI 1.09–1.34), suggesting that 5% of dyspepsia in the population is attributable to H. pylori. NSAIDs, low educational attainment, renting accommodation, absence of central heating, sharing a bed with siblings, and being married were also significantly associated with dyspepsia in this model. Smoking, but not drinking alcohol or coffee, was marginally associated with dyspepsia, but this finding was not robust. These factors were not associated with any dyspepsia subtype.CONCLUSIONS:H. pylori is significantly associated with dyspepsia and may be responsible for 5% of upper gastrointestinal symptoms in the community.

The cost-effectiveness of population Helicobacter pylori screening and treatment: a Markov model using economic data from a randomized controlled trial

Economic models have suggested that population Helicobacter pylori screening and treatment may be a cost‐effective method of reducing mortality from gastric cancer. These models are conservative as they do not consider that the programme may reduce health service peptic ulcer and other dyspepsia costs. We have evaluated the economic impact of population H. pylori screening and treatment over 2 years in a randomized controlled trial and have incorporated the results into an economic model exploring the impact of H. pylori eradication on peptic ulcer disease and gastric cancer.

Clinical trial: knowledge of negative Helicobacter pylori status reduces subsequent dyspepsia-related resource use

Background  Screening for Helicobacter pylori reduces dyspepsia and dyspepsia‐related costs in positive individuals.

A web and telephone randomisation service in one hour – the benefits and challenges of delivering a configurable randomisation system

No two trials are the same; even from an IS perspective. From differing data collection approaches, through to the myriad trial reports required to support them, we know there will always be a role for IT specialists delivering bespoke solutions to support the development and delivery of clinical trials. When however in 2013 we focused on how we developed our randomisation services, we found that in the majority of cases they used a method of randomisation that could be broadly categorised into either minimisation or randomised permuted blocks. What we also knew was that we were spending a great deal of time and effort both developing and importantly validating these applications. In early 2014 this awareness combined with a growing clamour from our trial teams to deliver randomisation services over the web (previously we only supported an automated telephone system) drove us to rethink entirely our strategy for delivering randomisation. Could we build a single configurable system to meet the similar needs of our trial teams which still had the flexibility to deal with the unexpected? Could we harness a single configuration to deliver those services both over the web and the telephone? Could we harness this configurable system to reduce the development and validation burden, therefore allowing us to deliver these systems both more quickly and more efficiently?