Helicobacter pylori eradication

Last reviewed 01/2018

H. pylori has been shown in some trials to improve symptoms in patients with non-ulcer dyspepsia.

The eradication of H. pylori as a treatment for non-ulcer dyspepsia is a controversial topic. Those in favour point to the possibility of later development of peptic ulcers or gastric carcinoma - both of which are correlated with H. pylori infection.

• the relationship between H. pylori infection and the risk of developing GORD is controversial
  • clinical epidemiological data indicated there is some negative correlation between the incidence of H. pylorii nfection and GORD. However, the essence of the relationship was not clear. The studies also showed that the reflux symptoms and quality of life were improved in GORD patients one year afterH. pylori eradication therapy (1)
• it is unclear whether H. pyloriinfection is the cause of non-ulcer dyspepsia
  • data from two Randomized controlled trial (RCT) studies (2,3) showed no relationship between the eradication of H. pylori and the symptoms of functional dyspepsia (FD)
  • however, another RCT study (4) considered that the dyspepsia was not improved obviously in 13% of participants in the treatment group, compared to 18.4% of participants in the placebo group seven years after the eradication of H. pylori. The difference was statistically significant (odds ratio (OR)0.69, 95%CI: 0.51-0.88). Therefore, eradication of H. pylori infection provided cumulative long-term benefit for dyspepsia patients

Reference:

• Hirata K, Suzuki H, Matsuzaki J, Masaoka T, Saito Y, Nishizawa T, et al. Improvement of reflux symptom related quality of life after Helicobacter pylori eradication therapy. J Clin Biochem Nutr 2013; 52: 172-178.
• Delaney BC, Qume M, Moayyedi P, Logan RF, Ford AC, Elliott C, et al. Helicobacter pylori test and treat versus proton pump inhibitor in initial management of dyspepsia in primary care: multicentre randomised controlled trial (MRC-CUBE trial). BMJ 2008; 336: 651-654.
• Sodhi JS, Javid G, Zargar SA, Tufail S, Shah A, Khan BA, et al. Prevalence of Helicobacter pylori infection and the effect of its eradication on symptoms of functional dyspepsia in Kashmir, India. J Gastroenterol Hepatol 2013; 28: 808-813.
• Harvey RF, Lane JA, Nair P, Egger M, Harvey I, Donovan J, et al. Clinical trial: the prolonged beneficial effect of Helicobacter pylori eradication on dyspepsia consultations - the Bristol Helicobacter Project. Aliment Pharmacol Ther 2010; 32: 394-400.