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| EDITORIAL |
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| Year : 2017 | Volume
: 1
| Issue : 2 | Page : 29-30 |
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Eradication of Helicobacter pylori: Does it improve functional dyspepsia?
Fahmi Yousef Ahmed Khan
Department of Medicine, Hamad General Hospital, Doha, Qatar
| Date of Web Publication | 7-Nov-2017 |
Correspondence Address:
Fahmi Yousef Ahmed Khan
Department of Medicine, Hamad General Hospital, P. O. Box: 3050, Doha
Qatar
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/LJMS.LJMS_38_17
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 |
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 | |  |
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| 2. | Kusters JG, van Vliet AH, Kuipers EJ. Pathogenesis of helicobacter pylori infection. Clin Microbiol Rev 2006;19:449-90. |
| 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. |
| 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. |
| 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. |
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| 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. |
| 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. |
| 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. |
| 11. | Talley NJ, Vakil N, Ballard ED 2 nd, Fennerty MB. Absence of benefit of eradicating helicobacter pylori in patients with nonulcer dyspepsia. N Engl J Med 1999;341:1106-11. |
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