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Should We Treat H. pylori in Patients with Nonulcer Dyspepsia?
Many patients with nonulcer dyspepsia are infected with H. pylori, but it is unclear whether therapy to eradicate the organism improves symptoms in these patients. Two randomized trials addressed this question.
The first study, from Scotland, enrolled 318 patients with at least four months of dyspepsia, H. pylori infection (as determined by a positive urea breath test plus either a positive urease test or positive histology), and absence of peptic ulcer or esophagitis by endoscopy. They received a two-week course of omeprazole/amoxicillin/metronidazole or omeprazole alone. At one year, dyspepsia had resolved in 21 percent of patients receiving triple therapy and 7 percent of those receiving omeprazole alone, a significant difference.
The second study was an international trial that assigned 328 H. pylori-infected (as determined by rapid urease test) dyspeptic patients to omeprazole/amoxicillin/clarithromycin or omeprazole alone. The trial was similar to the Scottish trial, although it used a different symptom rating scale and excluded patients with heartburn. At one year, the proportion of patients with resolution of symptoms was not significantly different in the two groups (27 percent vs. 21 percent).
Comment: While one of these studies showed a statistically significant benefit for triple therapy and the other did not, perhaps the most important observation is that H. pylori eradication did not eliminate dyspepsia for most patients in both trials. This outcome is not surprising, given that nonulcer dyspepsia is a rather broad and imprecise symptom complex.
— AS Brett
Published in Journal Watch General Medicine December 29, 1998
Citation(s):
McColl K et al. Symptomatic benefit from eradicating Helicobacter pylori infection in patients with nonulcer dyspepsia. N Engl J Med 1998 Dec 24 339 1869-1874.
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- Medline abstract (Free)
Blum AL et al. Lack of effect of treating Helicobacter pylori infection in patients with nonulcer dyspepsia. N Engl J Med 1998 Dec 24 339 1875-1881.
- Original article (Subscription may be required)
- Medline abstract (Free)