How should Helicobacter pylori negative patients be managed?

Stanghellini, Vincenzo; Tosetti, Cesare; Giorgio, Roberto De; Barbara, Giovanni; Salvioli, Beatrice; Corinaldesi, Roberto

doi:10.1136/gut.45.2008.i32

Cited by 9 publications

(7 citation statements)

References 37 publications

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“…These findings are similar to another study conducted in India by Basavaraj et a l(10) where mean age was 38.25 with slight male predominance, but study from Mayo clinic and Burger et al studyhave mean age slightly higher (50 years 54.6 years respectively) with female predominance [8,9]. However Stanghellini V et al demonstrated that Helicobacter pylori (H pylori) negative dyspeptic patients are younger when compared to H pylori positive cases with male predominance [11] As per diagnostic yield was concern, duodenal biopsy was diagnostic in 3 cases. We reported one case of celiac disease (confirmed with transglutaminase positivity).…”

Section: Discussionsupporting

confidence: 84%

Histomorphological study of duodenum with special reference to RUT (Rapid Urease Test) negative dyspepsia in a rural care setting

Chattopadhyay

Nayak

Basak

2019

Trop J Pathol Microbiol

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Introduction:In our institute duodenal biopsies are taken in patients having either, unexplained anemia, weight loss, recurrent loose stool, abdominal pain, dyspepsia or suspected malabsorption. In the present study we have evaluated histomorphological features of duodenal biopsies in patients presented with specifically Rapid Urease Test (RUT) negative dyspepsia. Materials and Methods: A retrospective observational study was conducted and data of duodenal biopsies were collected from January 2017 to December 2018. Histopathology slides of duodenal biopsies were reevaluated. We have correlated clinical and endoscopic findings with various histomorphological parameters. Results:We have included total 99 cases. Demographic profile of our study population shows wide age range (9 years to 74 years) with mean age 39.8 years and Male: Female ratio 1.1:1. Dyspepsia was the common presenting symptoms (64.6% cases) and malabsorption was suspected in 29 cases. 28.3% cases show villous architectural abnormalities which correlate significantly with endoscopic findings of duodenal nodularity. Moderate to severe lamina propria lymphoplasmacytic infiltration seen in 58.56% cases and correlates significantly with dyspeptic symptoms. Duodenal biopsy was diagnostic in 3% cases. Conclusion: Diagnostic yield of duodenal biopsy is low but informative with proper clinical background.

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Section: Discussionsupporting

confidence: 84%

Histomorphological study of duodenum with special reference to RUT (Rapid Urease Test) negative dyspepsia in a rural care setting

Chattopadhyay

Nayak

Basak

2019

Trop J Pathol Microbiol

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“… 41 Table 1 summarizes more recent placebo‐controlled published studies including at least 100 patients with functional dyspepsia and characterized by follow‐up periods of at least 12 months. We could identify only five of these studies, with two showing a significant (although weak) symptomatic improvement after H. pylori eradication, 31–42 and three yielding negative results 43,44 , 45 . It is difficult to reconcile these apparently conflicting results since several aspects of the studies are difficult to interpret.…”

Section: H Pylori Testing and Treatmentmentioning

confidence: 95%

“…Thirdly, dyspepsia is an extremely frequent condition and a uniform management strategy would result in a relevant impact on society at large. 38 Inappropriate overprescription of antibiotics, for instance, would inevitably contribute to the already serious problem of antibiotic resistance 39 not only among H. pylori strains, but also among other germs colonizing the human body, with potentially dramatic effects. Finally, there are also concerns about the long‐term risks of GORD and, possibly, oesophageal cancer after H. pylori eradication.…”

Section: H Pylori Testing and Treatmentmentioning

confidence: 99%

The continuing dilemma of dyspepsia

Stanghellini¹,

Tosetti²,

Barbara³

et al. 2000

Aliment Pharmacol Ther

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Dyspepsia drains a substantial proportion of healthcare resources in industrialized countries and an appropriate management strategy is needed. An aetiological role for Helicobacter pylori infection has been demonstrated in a number of pathological conditions associated with dyspepsia, such as peptic ulcer and gastric malignancies, but not in functional dyspepsia. Endoscopy and diagnosis-based treatment, H. pylori testing and eradication therapy, history taking and empirical therapy, are the main tools that are currently available for managing patients with upper gastrointestinal symptoms. Endoscopy identi®es malignancies and organic diseases of the proximal gut and therefore provides reassurance to both doctors and patients. It should be recommended in older patients with suspicious symptoms and it has proven to be more cost-effective than empirical H 2 -receptor antagonists in patients with ulcer-like symptoms. Empirical eradication in all dyspeptics without suspicious symptoms is a costeffective approach that cures the majority of peptic ulcers. Nevertheless, it does not control symptoms in the majority of patients, it may exacerbate gastrooesophageal re¯ux disease, and it encourages antibiotic resistance. The realities of current clinical practice require empirical therapy in most, if not all, the dyspeptics seen by general practitioners. A detailed history taking can help to diagnose gastro-oesophageal re¯ux disease and to identify suspicious symptoms. Furthermore, identi®cation of dyspepsia subgroups may provide guidance for empirical therapy. Nevertheless, even analysis of individual symptoms does not provide a suf®cient diagnostic yield to differentiate functional from organic dyspepsia and appropriate investigations are needed in patients with poor response to short-term therapy or frequent relapses. I N T R O D U C T I O NDyspepsia is an important and demanding clinical problem. The syndrome affects 20±40% of the population of industrialized countries and, despite the fact that only 20±25% of affected individuals seek medical help, it accounts for 5% of the everyday workload of general practitioners.1 Therefore, dyspepsia drains a substantial proportion of healthcare resources and an appropriate management strategy is needed. In patients who have not undergone diagnostic tests, dyspepsia is termed uninvestigated'.Dyspepsia can be secondary to a variety of organic, systemic and metabolic diseases, but in most cases no potential cause of symptoms is identi®ed even after extensive investigations. Dyspepsia in these cases is termed`functional' or`idiopathic'.`Non-ulcer dyspepsia' is an alternative term that can be misleading, since some doctors and investigators believe that functional dyspepsia should include only patients with symptoms suggestive of gastric or duodenal ulcer (namely different types of epigastric pain), in the absence of an ulcer crater at endoscopy. In patients complaining of dyspepsia who have not undergone diagnostic tests, dyspepsia is termed uninvestigated'. The pathogenesis of funct...

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“…Accepted 10-14 day regimens for H. pylori result in a cure rate of 80-90% (52). It is reasonable to expect that <50% of patients subjected to the "test and treat" strategy for dyspepsia will experience symptom resolution following therapy for H. pylori (53). Therefore, even if one were to assume that all patients with persistent infection remained symptomatic, a substantial percentage of patients with symptoms will not have persistent infection.…”

Section: Testing To Prove Cure Of H Pylori Infection After Treatmentmentioning

confidence: 99%