A prospective study of Helicobacter pylori nonulcer dyspepsia. Absence of benefit of eradicating Helicobacter pylori in patients with nonulcer dyspepsia. Helicobacter pylori infection and non-ulcer dyspepsia: the effect of treatment with colloidal bismuth subcitrate. Eradication of Helicobacter pylori affects symptoms in non-ulcer dyspepsia. Clinical Outcomes of Eradication of Helicobacter pylori in Nonulcer Dyspepsia in a Population with a High Prevalence of Infection: Results of a 12-Month Randomized, Double Blind, Placebo-Controlled Study Effect of Helicobacter pylori eradication therapy on dyspeptic symptoms in primary care. Helicobacter pylori eradication treatment does not benefit patients with nonulcer dyspepsia The proportion of upper gastrointestinal symptoms in the community associated with helicobacter pylori, lifestyle factors, and nonsteroidal anti-inflammatory drugs Cure of Helicobacter pylori infection does not improve symptoms in non‐ulcer dyspepsia patients—a double‐blind placebo‐controlled study Lack of effect of treatment for Helicobacter pylori on symptoms of nonulcer dyspepsia. Effect of a Community Screening for Helicobacter pylori: A 5-Yr Follow-Up Study Screening dyspepsia by serology to Helicobacter pylori Efficacy of Helicobacter pylori eradication in uninvestigated chronic dyspeptic staff members of a large factory: a prospective, long-term, follow-up, workplace outcome study Helicobacter pylori gastritis and non-ulcer dyspepsia in childhood. Efficacy of one-week triple antimicrobial therapy in eradicating the organism. There are some benefits for eradicating Helicobacter pylori in patients with non‐ulcer dyspepsia Campylobacter pylori and non-ulcer dyspepsia. 2. A prospective study in a Swedish population. Proton Pump Inhibitor or Testing for Helicobacter pylori as the First Step for Patients Presenting with Dyspepsia? A Cluster-Randomized Trial
Helicobacter pylori has been recognized as a contributing factor in gastrointestinal disease . A prospect i ve study was done to evaluate the treatment response of H. pylori nonulcer dyspepsia versus H. pylori-associated gastroduodenal ulcer . Eighty patients were prospect ively studied with esophagogastroduodenoscopy . The presence of H. pylori was determined by biopsy . Treatment for H. pylori was amoxicillin , metronidazole , and colloid bismuth with an anti-secretory drug . H. pylori was eradicated in 78.9 % of patients . Eighty percent of patients with nonulcer dyspepsia  symptomatically improved , compared to 100 % of ulcer patients ( p = 0.037 ) . Using stepwise logistic regression , H. pylori eradication was an independent predictor of symptomatic improvement . Therefore , this antibiotic regimen was less likely to lead to improvement in patients with nonulcer dyspepsia ; however , patients in whom the organism could be eradicated were more likely to benefit BACKGROUND The relation between Helicobacter pylori infection and nonulcer dyspepsia is uncertain . We tested the hypothesis that curing the infection will relieve symptoms of dyspepsia . METHODS We r and omly assigned 170 H. pylori-infected patients with nonulcer dyspepsia to receive twice-daily treatment with 20 mg of omeprazole , 1000 mg of amoxicillin , and 500 mg of clarithromycin for 14 days and 167 such patients to receive identical-appearing placebos ; all patients were then followed through regular visits for 12 months . Symptoms were scored on diary cards for seven days before each visit . A carbon-13 urea breath test was performed at base line and repeated at 1 and 12 months , and endoscopic biopsy was performed at 12 months to determine H. pylori status . Treatment was considered successful if the patient had only mild pain or discomfort or none at all . RESULTS The rate of eradication of H. pylori infection was 90 percent in the active-treatment group and 2 percent in the placebo group at four to six weeks ( P<0.001 ) . At 12 months , there was no significant difference between groups in the rate of successful treatment ( 46 percent in the active-treatment group and 50 percent in the placebo group ; relative likelihood of success with active treatment , 0.93 ; 95 percent confidence interval , 0.73 to 1.18 ; P=0.56 ) . There was also no significant difference in the rate of successful treatment at 12 months between patients who were H. pylori-negative and those who were H. pylori-positive ( 48 percent vs. 49 percent ) . The rates of successful treatment were also similar when patients were analyzed according to the type of dyspepsia ( ulcer-like , reflux-like , or dysmotility-like ) and changes in the quality of life . There was no significant association between treatment success and histologic improvement in chronic gastritis at 12 months ( P=0.68 ) . CONCLUSIONS We found no evidence that curing H. pylori infection in patients with nonulcer dyspepsia leads to relief of symptoms A study was undertaken to determine the role of Helicobacter pylori in non-ulcer dyspepsia ( NUD ) and to determine the efficacy of colloidal bismuth subcitrate ( CBS ) in the treatment of NUD . Seventy-one patients were r and omly allocated ( double blind ) to CBS or placebo , two tablets twice daily for 4 weeks . The severity of dyspepsia was scored and endoscopies performed before and after treatment , and antral biopsy specimens were taken for bacteriologic and histologic examination . Forty patients had H. pylori infection , and all had changes of chronic active gastritis .  H. pylori was cleared from 17 to 21 patients ( 81 % ) treated with CBS , whereas none of the 19 patients treated with placebo cleared the bacteria . Improvement in histology was noted in 15 of 21 patients ( 71.4 % ) treated with CBS , whereas no improvement was noted in any of the placebo controls . Thirty-one patients were negative for H. pylori . All had either normal gastric histology or minor degrees of inflammation . Seventeen of these patients received CBS , and 14 received placebo . All groups reported improvement in the symptom score ; however , the H. pylori-positive , CBS-treated group recorded a significantly higher improvement than the other groups ( p less than 0.001 ) . Relapse of H. pylori infection after initial clearance of the bacteria was high . Twelve of 16 patients evaluated relapsed 1 month after withdrawal of CBS BACKGROUND The relationship between Helicobacter pylori infection and non-ulcer dyspepsia is controversial . METHODS In a prospect i ve , long-term , double-blind study we r and omized 100 patients with non-ulcer dyspepsia and H. pylori infection to receive either of two treatment regimens : 1 ) bismuth-based triple therapy ( n = 50 ) or 2 ) bismuth + placebo ( n = 50 ) . RESULTS Triple therapy : subjects who became H. pylori-negative ( n = 42 ) showed a significant symptomatic response when interviewed at 8 weeks , 6 months , and 1 year ( P < 0.01 ) . This improvement was evident in the ' ulcer-like ' dyspepsia group at all times ( P < 0.01 ) but in the ' reflux-like ' and ' motility-like ' groups at 6 months only ( P < 0.01 ) . Those who remained H. pylori-positive showed no decrease in symptoms at 8 weeks , 6 months , and 1 year . Bismuth-placebo therapy : subjects who became H. pylori-negative ( n = 7 ) showed an improvement in symptoms at 8 weeks , 6 months , and 1 year . Those who continued to harbour the infection after treatment ( n = 42 ) showed an insignificant improvement in the motility and non-specific groups only . CONCLUSION This study shows that eradication of H. pylori results in a significant long-term reduction in symptoms of non-ulcer dyspepsia Ninety-one Helicobacter pylori-positive patients with nonulcer dyspepsia were r and omized to receive either lansoprazole , amoxicillin , and clarithromycin or lansoprazole and placebo . A vali date d question naire assessed dyspeptic symptoms at baseline and at 3 , 6 , and 12 months . Endoscopies and biopsies were performed at baseline and at 3 and 12 months . There was an overall trend , although not statistically significant , for a benefit of H. pylori eradication . Of the patients in the antibiotics group , 16 of 46 ( 35 % ) had symptomatic improvement , versus 9 of 43 ( 21 % ) in the control group ( P = 0.164 ) . In a secondary analysis , it was found that of the patients without endoscopic gastric erosions , 15 of 34 ( 44 % ) in the antibiotics group and 5 of 33 ( 15 % ) of controls had symptomatic improvement ( P = 0.015 ) . Helicobacter pylori eradication did not prove to be clinical ly beneficial , although a tendency to symptomatic benefit was detected . Further studies are necessary to confirm the implication s of endoscopic gastric erosions in these patients OBJECTIVE The aim was to explore the effect of eradication therapy on dyspeptic symptoms in patients with known peptic ulcer disease ( PUD ) . METHOD A total of 164 known dyspeptics and 147 non-dyspeptic attenders at six UK general practice s were recruited . The Helisal Rapid Blood test was performed in the practice s and eradication therapy left to the preference of the general practitioner . Patients were followed prospect ively by a Likert scaled symptom question naire and record review . The symptom question naire distinguished between patients known to have dyspepsia and those not . RESULTS There was a statistically significant decrease in dyspeptic symptoms in patients with known PUD who received eradication therapy ( n = 43 , Z = -2.63 , P = 0.009 ) . CONCLUSIONS Eradication of Helicobacter pylori in primary care can lead to a reduction in consumption of H2 receptor antagonists and hence cost savings . This study demonstrates that dyspeptic symptoms also decrease . The question naire could be used in further studies to evaluate the effect of management on dyspeptic symptoms in the primary care setting OBJECTIVES : The aim of this study was to assess the still controversial role of treatment of Helicobacter pylori ( H. pylori ) infection in patients with nonulcer dyspepsia . METHODS : We conducted a double-blind , r and omized , placebo-controlled , multicenter trial comparing the efficacy of 7 days of eradication treatment ( lansoprazole 15 mg b.i.d . , amoxicillin 1 g b.i.d . , and clarithromycin 500 mg b.i.d . ) with a control treatment ( lansoprazole 15 mg b.i.d . and placebo ) in H. pylori-infected patients with nonulcer dyspepsia .  13C breath tests were performed at baseline and during follow-up . We assessed patient symptoms , health status ( based on the SF-12 question naire ) , patient satisfaction , drug consumption , health care consultation behavior , and absenteeism related to dyspepsia over a 1-yr period . RESULTS : A total of 74 patients r and omized to eradication treatment and 70 patients r and omized to placebo were compared . The rate of eradication of H. pylori infection was 75 % in the active treatment group and 4 % in the placebo group ( p < 0.005 ) . The symptom score improved to a similar extent in the group receiving active treatment ( −4.0 ; 95 % CI = − 5.0 to −3.0 ) and placebo ( −3.6 ; 95 % CI = − 4.5 to −2.7 ) . Treatment response was not related to the severity or duration of initial symptoms or to the severity of gastritis on histology . Quality of life scores were comparable at 12 months . There was no significant difference in dyspepsia-related absenteeism or satisfaction with management of NUD . Patients receiving active treatment were more likely not to have had to use any dyspepsia treatment over the 12 months ( 60.8 % vs 44.3 % ; p = 0.047 ) . CONCLUSIONS : This study did not demonstrate any substantial benefit of curing H. pylori infection in patients with nonulcer dyspepsia . The study adds further evidence that H. pylori is not the main pathogenetic or therapeutic target in these patients OBJECTIVE : Upper gastrointestinal disorders are common in the community , yet the determinants of these symptoms are poorly characterized . The association between upper gastrointestinal symptoms and Helicobacter pylori ( H. pylori ) , socioeconomic status , nonsteroidal antiinflammatory drug ( NSAID ) use , smoking , alcohol , and coffee intake was assessed in a cross-sectional survey . METHODS : Subjects between the ages of 40–49 yr were r and omly selected from the lists of 36 primary care centers . Participants attended their local primary care center and were interviewed by a research er using a vali date d dyspepsia question naire . H. pylori status was determined by a nonfasting 13C-urea breath test . RESULTS : A total of 32,929 subjects were invited , and 8,407 ( 25 % ) attended and were eligible . Of these , 2,329 ( 28 % ) were H. pylori positive and 3,177 ( 38 % ) had dyspepsia . Also , 44 % of H. pylori-infected participants reported dyspepsia compared with 36 % of uninfected subjects [ odds ratio = 1.39 ; 95 % confidence interval ( CI ) 1.26–1.53 ] . H. pylori infection remained a significant risk factor for dyspepsia in a multiple logistic regression model ( odds ratio = 1.21 ; 95 % CI 1.09–1.34 ) , suggesting that 5 % of dyspepsia in the population is attributable to H. pylori . NSAIDs , low educational attainment , renting accommodation , absence of central heating , sharing a bed with siblings , and being married were also significantly associated with dyspepsia in this model . Smoking , but not drinking alcohol or coffee , was marginally associated with dyspepsia , but this finding was not robust . These factors were not associated with any dyspepsia subtype . CONCLUSIONS : H. pylori is significantly associated with dyspepsia and may be responsible for 5 % of upper gastrointestinal symptoms in the community It remains controversial whether the cure of H. pylori infection improves NUD symptoms . BACKGROUND Prior studies have yielded conflicting results on whether or not Helicobacter pylori causes nonulcer dyspepsia .  PATIENTS AND METHODS We enrolled 100 consecutive patients with nonulcer dyspepsia into a r and omized , double-blind , placebo-controlled trial . Patients with peptic ulcer disease , esophagitis , hepatobiliary disease , irritable bowel disease , or predominantly reflux-related symptoms were excluded by history and upper endoscopy . Helicobacter pylori infection was determined by biopsy and histologic examination . Serum H. pylori IgG antibodies and CagA status were determined by Western blot . Enrolled patients were r and omized to a 14-day regimen of omeprazole ( 20 mg twice daily ) and clarithromycin ( 500 mg three times daily ) or placebo .  Dyspeptic symptoms were assessed by use of a visual analog scale at baseline and at 1 , 3 , 6 , and 12 months after treatment . Follow-up upper endoscopy with biopsy was performed 4 weeks after treatment . Compliance was measured by tablet counts . RESULTS At 1 year , the change in dyspeptic symptoms was -24.0 ( 95 % confidence interval , -69.0 to 21.0 ) in the omeprazole and clarithromycin group and -24.2 in the placebo group ( 95 % confidence interval , -70.0 to 21.6 ) . Furthermore , patients with persistent H. pylori infection demonstrated a greater , but not significant , improvement in symptoms ( -40 + /- 144 [ mean + /- SD ] , -65 + /- 142 , -45 + /- 138 , and -39 + /- 163 ) than those with successful eradication ( -26 + /- 126 , -26 + /- 148 , -12 + /- 126 , and -25 + /- 151 ) at months 1 , 3 , 6 , and 12 , respectively . CONCLUSION Patients with nonulcer dyspepsia should not routinely be treated for H. pylori , since it is not a cause of this condition in most patients BACKGROUND AND AIMS : Helicobacter pylori ( H. pylori ) screening and eradication may reduce the incidence of gastric cancer , peptic ulcer , and ulcer complications , and it may reduce symptoms in a small proportion of individuals with functional dyspepsia . This study aim ed to assess the effect of community H. pylori screening and treatment on the prevalence of dyspepsia , and as secondary outcomes , the effect on dyspepsia-related health-care consumption and quality of life over 5 yr . METHODS : In 1998–1999 , individuals aged 40–65 yr were r and omized to H. pylori screening and treatment or to the control group .  Five years later , the participants were sent a question naire to assess the prevalence of dyspepsia and quality of life . In addition , we obtained information from registers on the use of endoscopies and prescription medication . An economic evaluation was done alongside the r and omized trial . RESULTS : Of 12,530 participants attending the study at baseline , 11,065 ( 88 % ) were traced and contacted at the 5-yr follow-up . The response rate was 94 % . At baseline , 17.5 % in the screened group were H. pylori-positive . The absolute reduction in dyspepsia during the first year was 4 % in the screened group , whereas no change was observed in the unscreened group ; this rate remained constant during the next 4 yr . Quality of life did not change . A small effect was found for dyspepsia-related consultations and sick leave days , but not on the prescription rate of ulcer drugs . A 33 % lower ulcer incidence ( 107 ulcers vs 148 ulcers ) was seen in the screened group compared to the unscreened group . CONCLUSION : A population H. pylori screening and treatment program in an H. pylori low-prevalence area had only a modest , but insignificant , effect on the rate of dyspepsia , and a modest , significant effect on the consultation rate and sick leave days for dyspepsia , but result ed in a decreased ulcer incidence . The intervention result ed in an increased cost due to H. pylori screening and treatment Owing to limited endoscopy re sources , various screening strategies for endoscopy have been proposed . Helicobacter pylori can be detected with high sensitivity and specificity by serology , and therefore we assessed the effects on diagnostic accuracy and endoscopic workload of a policy of screening clinic patients with dyspepsia before endoscopy  by a strategy based on age , Helicobacter pylori serology , and use of non-steroidal anti-inflammatory drugs .  1153 patients were studied , of whom 842 were of known histological H pylori status ( histology group ) and 293 had serum assessed prospect ively by in-house and commercial ELISAs for detection of IgG antibodies to H pylori . Overall , the screening strategy would have reduced endoscopy workload by 23.3 % ( 95 % confidence interval 20.9 - 25.8 % ) and would have had a sensitivity for detection of peptic ulcer of 97.4 % ( 94.5 - 99.1 % ) . No peptic ulcer or malignant disease was missed in the patients studied prospect ively , but 6 of 192 peptic ulcers in the histology group would have been missed . A policy of screening young dyspeptic patients for H pylori by serology is more sensitive than symptom-based screening strategies , and may have an important role in reducing endoscopy workload Background Current European guidelines propose Helicobacter pylori eradication for the initial management of patients under 45 years with uninvestigated dyspepsia without alarm symptoms . Until now , no study has assessed this strategy in occupational medicine . Aim To investigate the outcome of H. pylori eradication in staff members of a large factory with uninvestigated chronic dyspepsia in a prospect i ve , open , controlled , workplace outcome study in terms of the 1 year follow-up of dyspepsia and quality of life . Methods In 267 subjects with uninvestigated chronic dyspepsia ( 229 males , mean age 42 years ; range 22–62 years ) H. pylori status was assessed by using the 13C-urea breath test at baseline . H. pylori-positive subjects were offered 1 week eradication therapy with omeprazole 20 mg b.i.d . , clarithromycin 250 mg b.i.d . , and metronidazole 400 mg b.i.d . , and were retested after 2 months . Subjects with a negative 13C-urea breath test at 2 months were H. pylori-responders ; subjects still H. pylori-positive at this time were H. pylori-nonresponders . H. pylori-negative subjects at baseline were included as a reference . Dyspeptic symptoms , quality of life and health care utilization were assessed by question naires at baseline ( T0 ) , and at 2 ( T2 ) and 12 months ( T12 ) . Results One hundred and eleven of 267 ( 41.65 % ) subjects were H. pylori-positive at baseline . The infection was cured in 85 of 94 ( 90.4 % ) subjects . Upper abdominal pain and dyspeptic symptoms were significantly reduced and quality of life significantly increased in H. pylori responder subjects at T12 compared to baseline and to reference subjects ( P < 0.01 ) . At T12 42.3 % of H. pylori responder subjects showed complete relief of epigastric pain compared to 9.2 % in the reference group ( P < 0.001 ) . Furthermore , disease-related absence from work , visits to family physicians , and antacid consumption significantly decreased in H. pylori responder subjects compared with reference subjects ( P < 0.05 ) . Conclusion These data suggest that an H. pylori test- and -treat strategy in occupational medicine is effective for improving uninvestigated dyspepsia and quality of life and it may reduce dyspepsia related health care costs at a level of occupational medicine Efficacy of one-week triple antimicrobial therapy ( bismuth , tinidazole , amoxicillin ) as compared to the same drug combination given for 4 weeks was assessed in children with Helicobacter pylori ( H. pylori ) gastritis and non-ulcer dyspepsia . Twenty-six patients ( group A ) and 30 ( group B ) had one-week and four-week schedule , respectively . Eradication ( absence of organism at endoscopy at least 1 month after ending treatment ) was achieved in 84.6 % of group A ( 22 ) and 83.3 % of group B ( 25 ) , with marked reduction of histological gastritis score in both groups . Among patients with eradicated H. pylori , symptoms improved significantly in 14 and 16 patients of group A and B , respectively , but were still present in 17 ( 8 group A , 9 group B ) . The latter showed gastroparesis and abnormal gastro-oesophageal reflux at a subsequent diagnostic work-up and improved with prokinetic therapy . In 3 patients of group A and 3 of group B , symptoms improved despite persistence of bacterium into the stomach . Finally , in 3 cases ( 1 group A , 2 group B ) both symptoms and H. pylori infection were unchanged . At 6 month follow-up , symptoms were present in 7 patients ( 3 group A , 4 group B ) : 6 of them ( 3 group A , 3 group B ) showed H. pylori gastritis at endoscopy . We conclude that in children with dyspepsia and H. pylori gastritis one-week triple antimicrobial schedule is effective in eradicating bacterium ; however , detection of H. pylori gastritis in dyspeptic children does not invariably indicate a pathogenic role of the organism in these patients : The relationship between Helicobacter pylori infection and non‐ulcer dyspepsia is not established . In a consecutive prospect i ve series of 186 Swedish persons with the diagnosis of non-ulcer dyspepsia 71.5 % were found to have gastritis and /or bulbar duodenitis in endoscopic biopsies . Gastroduodenitis was associated with campylobacter pylori ( CP ) in 83.5 % of the cases . The double therapeutic approach using an antibiotic and a preparation containing bismuth in an uncontrolled therapeutic pilot trial result ed in improvement of the histological picture , disappearance of CP and amelioration of symptoms . It is concluded that CP-infection plays a central role in the pathogenesis of gastroduodenitis associated NUD OBJECTIVES : The optimal approach for management of patients with dyspepsia has not been determined . The aim of this study was to compare the efficacy of three strategies for management of dyspepsia :  empirical antisecretory therapy , testing for Helicobacter pylori ( H. pylori ) , or a combination of the two . METHODS : Cluster-r and omized trial in general practice s. Initial treatment with proton pump inhibitor ( PPI ) was performed in 222 patients , H. pylori test- and -eradicate in 250 patients , and  PPI followed by H. pylori-testing if symptoms improved in 250 patients . Symptoms , quality of life , patient satisfaction , and use of re sources were recorded during a 1-yr follow-up . RESULTS : The prevalence of H. pylori infection was 24 % . We found no difference among the three strategies ( p = 0.16 ) in terms of the proportion of days without dyspeptic symptoms . After 1 yr gastrointestinal symptom scores and quality -of-life scores had improved significantly and equally in the three groups ( p < 0.001 ) , but no statistically significant differences were found among the groups . The mean use of endoscopies per patient after 1 yr was higher in the PPI group ( 0.36 [ 95 % CI 0.30–0.43 ] ) than in the test- and -eradicate group ( 0.28 [ 95 % CI 0.23–0.34 ] ) and the combination group ( 0.22 [ 95 % CI 0.17–0.27 ] ) , p = 0.02 . H. pylori-positive patients given eradication therapy had more days without dyspeptic symptoms ( p < 0.001 ) , used less antisecretory therapy ( p < 0.01 ) , and were more satisfied ( p < 0.001 ) than H. pylori-negative patients . CONCLUSION : The strategies based on H. pylori test enjoyed similar symptom resolution , but reduced endoscopic workload and lower 1-yr total costs compared with empirical antisecretory therapy
Reports of strong associations in small observational studies without appropriate adjustment for potential confounding factors were not generally confirmed by larger and better- design ed studies .
The available evidence indicates that there is no strong association between H pylori and dyspepsia , but there is insufficient evidence to confirm or refute the existence of a modest association
BACKGROUND Previous studies have yielded conflicting results and substantial uncertainty about any independent association of Helicobacter pylori infection with dyspepsia , and about any benefits of antibiotic treatments for nonulcer or uninvestigated dyspepsia .
OBJECTIVES To perform a systematic review of the literature to determine whether chronic infection with H pylori is relevant to nonulcer or uninvestigated dyspepsia .