Eradication of Helicobacter pylori prevents ulcer development in patients with ulcer‐like functional dyspepsia

Abstract

Background: Although the eradication of Helicobacter pylori infection benefits patients with gastric or duodenal ulcers, the value of eradicating the infection in the patients with functional dyspepsia (FD) remains controversial. Aims: To determine whether eradicating H. pylori can prevent the subsequent development of ulcers or relieve the symptoms of functional dyspepsia patients. Methods: In a double‐blind, placebo‐controlled trial, 161 patients infected with H. pylori who had functional dyspepsia were randomly assigned to 7 days of treatment with a lansoprazole‐based triple therapy or placebo and then followed for 1 year. The main outcome measures were the development of peptic ulcers and the resolution of symptoms. Results: H. pylori was eradicated in 63 out of 81 patients (78%) in the treatment group and none of the 80 patients (0%) in the placebo group. During the follow‐up period, two patients in the treatment group and six patients in the placebo group developed peptic ulcers at repeat endoscopy (2.5% vs. 7.5%; 95% CI: –12 to 2). The reduction in ulcer rates was statistically significant in the ‘ulcer‐like’ sub‐group (0% vs. 16.7%; 95% CI: –32 to –2), but not in the ‘dysmotility‐like’ and ‘unclassifiable’ sub‐groups. Regarding symptom response, the resolution rates of symptoms were similar between the treatment and placebo groups (58.0% vs. 55.0%, 95% CI: –12 to 18). Additionally, no significant differences existed in the symptom responses between the treatment and control arms in each of the dyspepsia sub‐groups. Conclusions: Eradicating H. pylori can prevent the subsequent development of peptic ulcers in the patients with ‘ulcer‐like’ functional dyspepsia. However, this approach does not significantly reduce the symptoms of functional dyspepsia patients.

Helicobacter Pylori Infection in Peptic Ulcer Disease

“…210 Eradication of H. Pylori may also reduce the incidence of peptic ulcer in patients with ulcer-like functional dyspepsia. 211 Therefore, the test-and-treat strategy is recommended in patients with uninvestigated dyspepsia who are under the age of 55 yrs or 45 yrs (depending upon the specific set of guidelines) and have no "alarm features". However, this strategy has been criticised.…”

Patterns of gastritis and the effect of eradicating Helicobacter pylori on gastro‐oesophageal reflux disease in Western patients with non‐ulcer dyspepsia

“…[3][4][5][6][7] The results of H. pylori eradication in non-ulcer dyspepsia have been mixed, with some studies showing no benefit and others demonstrating improvement in symptoms and prevention of future ulcer disease. [8][9][10] A recent meta-analysis demonstrated modest efficacy for H. pylori eradication in alleviating dyspeptic symptoms with a number needed to treat of 19. 11 A subsequent meta-analysis using individual patient data suggested that the benefit of eradication was similar whether patients with predominant epigastric pain or predominant heartburn were studied. 12 With the declining rates of peptic ulcer disease in most Western countries, H. pylori treatment is being frequently administered in non-ulcer dyspepsia.…”

Helicobacter pylori eradication versus prokinetics in the treatment of functional dyspepsia: a randomized, double-blind study

“…14,18,19 A similar proportion of patients in each of these categories responded to H. pylori eradication therapy. Our results are consistent with these observations.…”