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EDITORIAL
Year : 2017  |  Volume : 1  |  Issue : 2  |  Page : 29-30

Eradication of Helicobacter pylori: Does it improve functional dyspepsia?


Department of Medicine, Hamad General Hospital, Doha, Qatar

Date of Web Publication7-Nov-2017

Correspondence Address:
Fahmi Yousef Ahmed Khan
Department of Medicine, Hamad General Hospital, P. O. Box: 3050, Doha
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/LJMS.LJMS_38_17

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How to cite this article:
Ahmed Khan FY. Eradication of Helicobacter pylori: Does it improve functional dyspepsia?. Libyan J Med Sci 2017;1:29-30

How to cite this URL:
Ahmed Khan FY. Eradication of Helicobacter pylori: Does it improve functional dyspepsia?. Libyan J Med Sci [serial online] 2017 [cited 2019 Feb 19];1:29-30. Available from: http://www.ljmsonline.com/text.asp?2017/1/2/29/217803

Helicobacter pylori is a ubiquitous organism that is present in about 50% of the global population.[1] Chronic infection with H. pylori causes atrophic and even metaplastic changes in the stomach, and it represents a key factor in the etiology of various gastrointestinal diseases, ranging from chronic active gastritis without clinical symptoms to peptic ulceration, gastric adenocarcinoma, and gastric mucosa-associated lymphoid tissue lymphoma. The most common route of H. pylori infection is by either oral-to-oral or fecal-to-oral contact.[2] Functional dyspepsia is a common functional gastrointestinal disorder with reported prevalence rate of 21%.[3] The causes of functional dyspepsia are multifactorial, but H. pylori infection is one likely candidate. Therapeutic benefits and symptom improvement after the eradication of H. pylori remain controversial as previous trials that focused on the symptomatic benefits of eradicating H. pylori infections in patients with functional dyspepsia have yielded conflicting results.

Some trials have shown that the eradication of H. pylori provides significant benefits to patients with functional dyspepsia. Results of meta-analysis showed that H. pylori eradication therapy conferred a small but significant benefit in functional dyspepsia.[4] Moreover, in HEROES trial,[5] Mazzoleni et al. randomly assigned 404 patients; 201 were assigned to be treated with antibiotics (antibiotic group) and 203 to a control group. They found that the antibiotic group showed significant improvement in their symptoms when compared with control group. This study is important because it was conducted entirely in primary care and it demonstrates a clear benefit of eradication therapy in functional dyspepsia. A recent trial from Korea has found that 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.[3] Three recent meta-analyses [6],[7],[8] found that H. pylori eradication therapy compared to no eradication therapy has a statistically significant but small magnitude of benefit for symptom relief.

On the other hand, many trials failed to show any effect of eradication therapy on symptoms of functional dyspepsia.[9],[10],[11] Recently, Yazdanbod et al. randomly assigned a total of 359 patients; 186 patients were assigned to eradication treatment and 173 patients were randomized to placebo. The results of this study provide no evidence that H. pylori eradication leads to relief of symptoms 12 months after treatment.[9]

In summary, we conclude that H. pylori eradication provides a small and highly variable symptomatic benefit in patients with functional dyspepsia 12 months after therapy; this may be attributed to the fact that gastritis-induced atrophy takes some time to recover. Therefore, it is acceptable to offer H. pylori eradication therapy to the infected patients with functional dyspepsia.

 
  References Top

1.
Wang F, Meng W, Wang B, Qiao L. Helicobacter pylori-induced gastric inflammation and gastric cancer. Cancer Lett 2014;345:196-202.  Back to cited text no. 1
    
2.
Kusters JG, van Vliet AH, Kuipers EJ. Pathogenesis of helicobacter pylori infection. Clin Microbiol Rev 2006;19:449-90.  Back to cited text no. 2
    
3.
Kim YJ, Chung WC, Kim BW, Kim SS, Kim JI, Kim NJ, et al. Is Helicobacter pylori associated functional dyspepsia correlated with dysbiosis? J Neurogastroenterol Motil 2017;23:504-16.  Back to cited text no. 3
    
4.
Jaakkimainen RL, Boyle E, Tudiver F. Is helicobacter pylori associated with non-ulcer dyspepsia and will eradication improve symptoms? A meta-analysis. BMJ 1999;319:1040-4.  Back to cited text no. 4
    
5.
Mazzoleni LE, Sander GB, Francesconi CF, Mazzoleni F, Uchoa DM, De Bona LR, et al. Helicobacter pylori eradication in functional dyspepsia: HEROES trial. Arch Intern Med 2011;171:1929-36.  Back to cited text no. 5
    
6.
Du LJ, Chen BR, Kim JJ, Kim S, Shen JH, Dai N, et al. Helicobacter pylori eradication therapy for functional dyspepsia: Systematic review and meta-analysis. World J Gastroenterol 2016;22:3486-95.  Back to cited text no. 6
    
7.
Zhao B, Zhao J, Cheng WF, Shi WJ, Liu W, Pan XL, et al. Efficacy of helicobacter pylori eradication therapy on functional dyspepsia: A meta-analysis of randomized controlled studies with 12-month follow-up. J Clin Gastroenterol 2014;48:241-7.  Back to cited text no. 7
    
8.
Moayyedi P, Soo S, Deeks JJ, Delaney B, Harris A, Innes M, et al. Eradication of Helicobacter pylori for non-ulcer dyspepsia. Cochrane Database Syst Rev 2011;(2):CD002096. Doi:10.1002/14651858.CD002096.pub5.  Back to cited text no. 8
    
9.
Yazdanbod A, Salimian S, Habibzadeh S, Hooshyar A, Maleki N, Norouzvand M, et al. Effect of helicobacter pylori eradication in Iranian patients with functional dyspepsia: A prospective, randomized, placebo-controlled trial. Arch Med Sci 2015;11:964-9.  Back to cited text no. 9
    
10.
Froehlich F, Gonvers JJ, Wietlisbach V, Burnand B, Hildebrand P, Schneider C, et al. Helicobacter pylori eradication treatment does not benefit patients with nonulcer dyspepsia. Am J Gastroenterol 2001;96:2329-36.  Back to cited text no. 10
    
11.
Talley NJ, Vakil N, Ballard ED 2nd, Fennerty MB. Absence of benefit of eradicating helicobacter pylori in patients with nonulcer dyspepsia. N Engl J Med 1999;341:1106-11.  Back to cited text no. 11
    




 

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