Smoking increases the treatment failure for Helicobacter pylori eradication

Am J Med. 2006 Mar;119(3):217-24. doi: 10.1016/j.amjmed.2005.10.003.


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.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Helicobacter Infections / drug therapy*
  • Helicobacter pylori / pathogenicity*
  • Humans
  • Proton Pump Inhibitors*
  • Randomized Controlled Trials as Topic
  • Smoking / adverse effects*
  • Treatment Failure


  • Anti-Bacterial Agents
  • Proton Pump Inhibitors