IsHelicobacter pyloriAssociated Functional Dyspepsia Correlated With Dysbiosis?

Abstract

Background/AimsTo assess the long-term effect of Helicobacter pylori eradication on symptomatic improvement according to the type of antibiotic and the duration of treatment in H. pylori-associated functional dyspepsia. MethodsWe searched Pubmed, Embase, CINAHL, and the Cochrane library databases for randomized controlled trials written in English and undertaken up to August 2016 that met our eligibility criteria. The search methodology used combinations of the following keywords: Helicobacter pylori OR H. pylori OR HP; dyspepsia OR functional dyspepsia OR non-ulcer dyspepsia; eradication OR cure OR treatment. The study outcome was the summary odds ratio (OR) for symptomatic improvement in H. pylori-associated functional dyspepsia with successful eradication therapy. Subgroup analyses were performed based on the type of antibiotic, and the duration of treatment, whether or not patients had symptoms of irritable bowel syndrome, and on race. ResultsSixteen randomized controlled trials met the inclusion criteria. The summary OR for symptomatic improvement in patients in our eradication group was 1.33 (95% confidence interval [CI], 1.16-1.54; P < 0.01). In a subgroup analysis on type of antibiotic, symptomatic improvement with metronidazole-containing regimen (OR, 1.87; 95% CI, 1.26-2.77) was better than treatment with clarithromycin (OR, 1.29; 95% CI, 1.11-1.50). H. pylori eradication therapy given for 10-14 days was the more effective for symptom improvement than 7-day therapy. When the studies excluding irritable bowel syndrome cases were analyzed, there were no therapeutic effects of H. pylori eradication on symptomatic improvement. ConclusionsIn the clinical setting, the most effective H. pylori eradication regimen for functional dyspepsia to provide relief of symptoms is a metronidazole-based treatment regimen for at least 10 days. The explanation for this is that H. pylori-associated functional dyspepsia could be associated with dysbiosis.

Novel concepts in the pathophysiology and treatment of functional dyspepsia

“…The effect of acid suppression on the microbiome is highly relevant as PPIs are frequently scrutinised because of overprescribing and potential long-term adverse events. PPI-induced dysbiosis may also help explain the limited efficacy of long-term PPIs as the current first-line treatment in FD90 and the possibility of persisting dyspeptic symptoms in a subgroup of patients on PPIs 117. Other treatments targeting the microbiome in FD look promising but require confirmation.…”

“…These limited data suggest that stopping PPIs in patients without a clear benefit may be a first option to target dysbiosis in FD. Eradication therapy with antibiotics improves symptoms in Helicobacter pylori -related dyspepsia (HpD), and the effect was greater with metronidazole and in patients with microscopic duodenitis,117 118 suggesting an effect on the duodenal microbiome, which is distinct from Hp eradication per se 119…”

Helicobacter pylori and nonmalignant upper gastrointestinal diseases

“…H. pylori eradication therapy, given for 10‐14 days, was more effective than 7‐day therapy. When the studies excluding irritable bowel syndrome cases were analyzed, there were no benefits due to H. pylori eradication . The best explanation for these results is that H. pylori ‐associated dyspepsia could be associated with dysbiosis…”

Is there an association between Helicobacter pylori infection and irritable bowel syndrome? A meta-analysis

“…The mode of transmission of H. pylori is unclear, but believed to be fecal-oral. H. pylori , especially strains that produce cytotoxin-associated gene A (CagA) protein, causes chronic inflammation in the stomach and duodenum, microbial dysbiosis[7] as well as elevated systemic inflammation[8]. H. pylori infection has been linked to several conditions, including dyspepsia and even hyperemesis gravidarum[9].…”