A prospective study of Helicobacter pylori nonulcer dyspepsia. Absence of benefit of eradicating Helicobacter pylori in patients with nonulcer dyspepsia. Lack of effect of treatment for Helicobacter pylori on symptoms of nonulcer dyspepsia. Helicobacter pylori eradication treatment does not benefit patients with nonulcer dyspepsia Treating Helicobacter pylori infection in primary care patients with uninvestigated dyspepsia: the Canadian adult dyspepsia empiric treatment—Helicobacter pylori positive (CADET-Hp) randomised controlled trial Symptomatic benefit from eradicating Helicobacter pylori infection in patients with nonulcer 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 Lack of effect of treating Helicobacter pylori infection in patients with nonulcer dyspepsia. Omeprazole plus Clarithromycin and Amoxicillin Effect One Year after Treatment (OCAY) Study Group. Efficacy of Helicobacter pylori eradication in uninvestigated chronic dyspeptic staff members of a large factory: a prospective, long-term, follow-up, workplace outcome study Economic evaluation of Helicobacter pylori eradication in the CADET‐Hp randomized controlled trial of H. pylori‐positive primary care patients with uninvestigated dyspepsia Helicobacter pylori infection and the development of gastric cancer. Treatment of uninvestigated dyspepsia with cisapride for patients with negative Helicobacter pylori serologies The long‐term effect of Helicobacter pylori eradication therapy on symptoms in dyspeptic patients with fundic atrophic gastritis Costs and benefits of a test‐and‐treat strategy in Helicobacter pylori‐infected subjects: a prospective intervention study in general practice Seven‐day therapy for Helicobacter pylori in the United States Antacids reduce Campylobacter pylori colonization without healing the gastritis in patients with nonulcer dyspepsia and erosive prepyloric changes. Dyspepsia management in primary care: a decision analysis of competing strategies. Anxiety is associated with uninvestigated and functional dyspepsia (Rome III criteria) in a Swedish population-based study. Evaluation of a four-drug, three-antibiotic, nonbismuth-containing "concomitant" therapy as first-line Helicobacter pylori eradication regimen in Greece. There are some benefits for eradicating Helicobacter pylori in patients with non‐ulcer dyspepsia Does the ‘test‐and‐treat’ strategy work in primary health care for management of uninvestigated dyspepsia? A prospective two‐year follow‐up study of 1552 patients Bismuth subsalicylate suppression ofHelicobacter pylori in nonulcer dyspepsia: A double-blind placebo-controlled trial Eradication of Helicobacter pylori prevents ulcer development in patients with ulcer‐like functional dyspepsia Pretreatment Gastric Histology Is Helpful to Predict the Symptomatic Response After H. pylori Eradication in Patients with Nonulcer Dyspepsia The proportion of upper gastrointestinal symptoms in the community associated with helicobacter pylori, lifestyle factors, and nonsteroidal anti-inflammatory drugs Are routine duodenal and antral biopsies useful in the management of "functional" dyspepsia? A diagnostic and therapeutic study. Helicobacter pylori infection and non-ulcer dyspepsia: the effect of treatment with colloidal bismuth subcitrate. Testing for Helicobacter pylori infection: validation and diagnostic yield of a near patient test in primary care How Do Clinicians Practicing in the U.S. Manage Helicobacter pylori-Related Gastrointestinal Diseases? A Comparison of Primary Care and Specialist Physicians Double blind trial of colloidal bismuth subcitrate versus placebo in Helicobacter pylori positive patients with non-ulcer dyspepsia.
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 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 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 Abstract Objective : To determine whether a “ test for Helicobacter pylori and treat ” strategy improves symptoms in patients with uninvestigated dyspepsia in primary care . Design : R and omised placebo controlled trial . Setting : 36 family practice s in Canada . Participants : 294 patients positive for H pylori ( 13C- urea breath test ) with symptoms of dyspepsia of at least moderate severity in the preceding month . Intervention : Participants were r and omised to twice daily treatment for 7 days with omeprazole 20 mg , metronidazole 500 mg , and clarithromycin 250 mg or omeprazole 20 mg , placebo metronidazole , and placebo clarithromycin . Patients were then managed by their family physicians according to their usual care . Main outcome measures : Treatment success defined as no symptoms or minimal symptoms of dyspepsia at the end of one year . Societal healthcare costs collected prospect ively for a secondary evaluation of actual mean costs . Results : In the intention to treat population ( n=294 ) , eradication treatment was significantly more effective than placebo in achieving treatment success ( 50 % v 36 % ; P=0.02 ; absolute risk reduction=14 % ; number needed to treat=7 , 95 % confidence interval 4 to 63 ) . Eradication treatment cured H pylori infection in 80 % of evaluable patients . Treatment success at one year was greater in patients negative for H pylori than in those positive for H pylori ( 54 % v 39 % ; P=0.02 ) . Eradication treatment reduced mean annual cost by $ C53 ( 86 to 180 ) per patient . Conclusions : A “ test for H pylori with 13C-urea breath test and eradicate ” strategy shows significant symptomatic benefit at 12 months in the management of primary care patients with uninvestigated dyspepsia . What is already known on this topic Dyspepsia is a common problem in primary health care , although controversy exists about its definition Studies of H pylori eradication in patients with uninvestigated dyspepsia have shown reduced need for endoscopy and thus significant cost savings compared with a strategy of prompt endoscopy The “ test for H pylori and treat ” strategy has been recommended for uninvestigated dyspepsia , but there have been no r and omised controlled trials showing improvement in symptoms What this study adds When given eradication treatment in primary care , H pylori positive patients with uninvestigated dyspepsia show improvement in overall dyspepsia symptoms at 12 months This supports the “ test for H pylori and treat ” BACKGROUND The eradication of Helicobacter pylori infection is beneficial in patients with gastric or duodenal ulcers . The value of eradicating the infection in patients with dyspepsia and no evidence of ulcer disease is not known . METHODS We performed a r and omized , placebo-controlled trial comparing the efficacy of treatment for two weeks with 20 mg of omeprazole orally twice daily , 500 mg of amoxicillin three times daily ( with 500 mg of tetracycline three times daily substituted for amoxicillin in patients allergic to penicillin ) , and 400 mg of metronidazole three times daily ( 160 patients ) with that of omeprazole alone  ( 158 patients ) for resolving symptoms of dyspepsia in patients with H. pylori infection but no evidence of ulcer disease on upper gastrointestinal endoscopy . Symptoms were assessed with the Glasgow Dyspepsia Severity Score , with resolution of symptoms defined as a score of 0 or 1 in the preceding six months ( maximal score , 20 ) . One year later the patients were assessed to determine the frequency of the resolution of symptoms . RESULTS One month after the completion of treatment , 132 of 150 patients ( 88 percent ) in the group assigned to received omeprazole and antibiotics had a negative test for H. pylori , as compared with 7 of 152 ( 5 percent ) in the group assigned to receive omeprazole alone . One year later , dyspepsia had resolved in 33 of 154 patients ( 21 percent ) in the group given omeprazole and antibiotics , as compared with 11 of 154 ( 7 percent ) in the group given omeprazole alone ( 95 percent confidence interval for the difference , 7 to 22 percent ; P<0.001 ) . Among the patients in the group given omeprazole and antibiotics , the symptoms resolved in 26 of the 98 patients ( 27 percent ) who had had symptoms for five years or less , as compared with 7 of the 56 patients ( 12 percent ) who had had symptoms for more than five years ( P=0.03 ) . CONCLUSIONS In patients with H. pylori infection and nonulcer , or functional , dyspepsia , treatment with omeprazole and antibiotics to eradicate the infection is more likely to resolve symptoms than treatment with omeprazole alone 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 BACKGROUND It is uncertain whether treatment of Helicobacter pylori infection relieves symptoms in patients with nonulcer , or functional , dyspepsia . METHODS We conducted a double-blind , multicenter trial of patients with H. pylori infection and dyspeptic symptoms ( moderate-to-very-severe pain and discomfort centered in the upper abdomen ) . Patients were excluded if they had a history of peptic ulcer disease or gastroesophageal reflux disease and had abnormal findings on upper endoscopy . Patients were r and omly assigned to seven days of treatment with 20 mg of omeprazole twice daily , 1000 mg of amoxicillin twice daily , and 500 mg of clarithromycin twice daily or with omeprazole alone and then followed up for one year . Treatment success was defined as the absence of dyspeptic symptoms or the presence of minimal symptoms on any of the 7 days preceding the 12-month visit . RESULTS Twenty of the 348 patients were excluded after r and omization because they were not infected with H. pylori , were not treated , or had no data available . For the remaining 328 patients ( 164 in each group ) , treatment was successful for 27.4 percent of those assigned to receive omeprazole and antibiotics and 20.7 percent of those assigned to receive omeprazole alone ( P=0.17 ; absolute difference between groups , 6.7 percent ; 95 percent confidence interval , -2.6 to 16.0 ) . After 12 months , gastritis had healed in 75.0 percent of the patients in the group given omeprazole and antibiotics and in 3.0 percent of the patients in the omeprazole group ( P<0.001 ) ; the respective rates of H. pylori eradication were 79 percent and 2 percent . In the group given omeprazole and antibiotics , the rate of treatment success among patients with persistent H. pylori infection was similar to that among patients in whom the infection was eradicated ( 26 percent vs. 31 percent ) . There were no significant differences between the groups in the quality of life after treatment . CONCLUSIONS In patients with nonulcer dyspepsia , the eradication of H. pylori infection is not likely to relieve symptoms 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 Background : Adult Helicobacter pylori‐positive patients by 13C‐urea breath test with uninvestigated dyspepsia symptoms were r and omized to 1‐week eradication treatment with omeprazole , metronidazole and clarithromycin ( OMC ) vs. omeprazole and placebo antimicrobials ( OPP ) in the Canadian Adult Dyspepsia Empiric Treatment — H. pylori‐positive ( CADET‐Hp ) study BACKGROUND Although many studies have found an association between Helicobacter pylori infection and the development of gastric cancer , many aspects of this relation remain uncertain . METHODS We prospect ively studied 1526 Japanese patients who had duodenal ulcers , gastric ulcers , gastric hyperplasia , or nonulcer dyspepsia at the time of enrollment ; 1246 had H. pylori infection and 280 did not . The mean follow-up was 7.8 years ( range , 1.0 to 10.6 ) . Patients underwent endoscopy with biopsy at enrollment and then between one and three years after enrollment . H. pylori infection was assessed by histologic examination , serologic testing , and rapid urease tests and was defined by a positive result on any of these tests . RESULTS Gastric cancers developed in 36 ( 2.9 percent ) of the infected and none of the uninfected patients . There were 23 intestinal-type and 13 diffuse-type cancers . Among the patients with H. pylori infection , those with severe gastric atrophy , corpus-predominant gastritis , and intestinal metaplasia were at significantly higher risk for gastric cancer . We detected gastric cancers in 21 ( 4.7 percent ) of the 445 patients with nonulcer dyspepsia , 10 ( 3.4 percent ) of the 297 with gastric ulcers , 5 ( 2.2 percent ) of the 229 with gastric hyperplastic polyps , and none of the 275 with duodenal ulcers . CONCLUSIONS Gastric cancer develops in persons infected with H. pylori but not in uninfected persons . Those with histologic findings of severe gastric atrophy , corpus-predominant gastritis , or intestinal metaplasia are at increased risk . Persons with H. pylori infection and nonulcer dyspepsia , gastric ulcers , or gastric hyperplastic polyps are also at risk , but those with duodenal ulcers are not OBJECTIVE : The aim of this study was to compare symptoms for patients with uninvestigated dyspepsia and a negative Helicobacter pylori serology who were treated with cisapride or placebo .  METHODS : Helicobacter pylori-seronegative patients with chronic dyspepsia were r and omized to receive cisapride 10 mg t.i.d . or placebo t.i.d . for 30 days . Symptom scores were performed 1 month and 3 months after r and omization . Outcomes measured were dyspepsia symptom scores and a treatment “ success ” variable defined as absence of symptoms or decrease in the most severe individual symptom by two grade s. RESULTS : A total of 60 patients were r and omized ; 56 completed the 1-month follow-up and 40 completed the 3-month follow-up interview . The mean score for all patients at the time of entry was 11.0 and declined to 8.3 and 8.2 at 1 and 3 months , respectively , after r and omization . At 1 month and 3 months after r and omization , there was no significant difference in the number of patients meeting the “ success ” variable for patients receiving cisapride as compared to placebo . The mean decline in symptom severity scores was not significantly different for patients receiving placebo or cisapride at 1 month ( mean , −2.8 vs−3.1 ; difference = 0.3 , p = 0.74 ) or 3 months ( −3.1 vs−2.6 , difference = −0.5 , p = 0.58 ) after r and omization . CONCLUSIONS : No significant difference in the severity of dyspeptic symptoms was found for patients receiving cisapride as compared to placebo in the setting of uninvestigated dyspepsia and a negative Helicobacter pylori serology Aim : To investigate whether curing Helicobacter pylori infection improves symptoms over the long‐term in Japanese patients with nonulcer dyspepsia and fundic atrophic gastritis Objective To identify health outcomes and costs/savings of a Helicobacter pylori test‐ and ‐treat strategy in patients using acid suppressants chronically . Design Prospect i ve intervention study . Patients were tested for H. pylori infection and treated with 14 days of ranitidine bismuth citrate ( RBC ) 400 mg ( b.i.d . ) and clarithromycin 500 mg if infected . Cure was determined after six months . Setting General practice . Participants Patients using acid suppressants chronically were identified by a computer search ; 184 patients gave written consent and were included . Main outcome measures Serology , symptom question naire , medication history , quality of life determination , costs/savings . Results Out of 184 patients , 85 ( 46 % ) had positive serology . A cure rate of 61/80 ( 76 % ) was achieved . The intervention group showed significant symptom relief . Benefits were evident in patients with ulcer disease but also in patients with uninvestigated dyspepsia . Quality of life improved for cured patients in the intervention group . No improvements for dyspeptic symptoms or quality of life occurred in the H. pylori‐negative group . After six months , significant savings for medication use had occurred in treated patients diagnosed as ulcer disease or non‐ulcer dyspepsia . Savings on drug use and doctor visits equalize with costs for tests and antibiotics after nine months . Although less , costs for drugs also decreased significantly in the H. pylori‐negative group . Therefore , for the study population , costs and savings are even after 6.5 months . Conclusions A test‐ and ‐treat strategy for H. pylori , systematic ally applied at the population level in patients using acid suppressants chronically , results in significant health benefits and economic savings within 1 year of follow‐up . Eur J Gastroenterol Hepatol 12:319‐325 © 2000 Lippincott Williams & Wilkins European Journal of Gastroenterology & Hepatology 2000 , Background : The ideal duration of Helicobacter pylori treatment in the United States and whether eradication therapy is as successful in nonulcer dyspepsia as in peptic ulcer disease are controversial topics Antral biopsy specimens from 89 consecutive patients with nonulcer dyspepsia and erosive prepyloric changes included in a prospect i ve , r and omized , double-blind 4-wk study of the effect of an aluminum-magnesium antacid ( 120 mmol/day ) or pirenzepine ( 50 mg b.i.d . ) vs. placebo were examined histologically . Campylobacter pylori ( CP ) was found by light microscopy of silver-stained sections in 25 patients ( 28 % ) . Campylobacter pylori-positive patients were on average older than CP-negative patients ( p = 0.02 ) . There was a strong association between CP colonization and acute inflammation ( p less than 0.001 ) , both being rare in the absence of chronic inflammation . During treatment with antacids , the density of CP decreased ( p less than 0.001 ) without any improvement of the inflammatory reaction . On the contrary , the number of patients with gastritis tended to increase after antacids as compared with placebo ( p less than 0.10 ) . A separate analysis showed no symptomatic effect of the drugs . Thus , neither nonulcer dyspepsia nor erosive prepyloric changes are strongly associated with antral CP colonization or acute inflammation . Aluminum-magnesium antacids may suppress antral CP infection without healing the gastritis or relieving symptoms One-third of adults experience pain or discomfort in the upper abdomen during a given year.1 Of these , 1/4 seek treatment , making dyspepsia the presenting complaint of 4 % of patients visiting primary care physicians.2,3 The optimal approach to uncomplicated dyspepsia in this setting remains controversial . Previous guidelines recommended initial antisecretory therapy , while reserving additional interventions for nonresponders.4 However , as evidence mounts to suggest that Helicobacter pylori eradication may relieve symptoms in many patients , 5 several consensus statements have suggested a “ test and treat ” approach for patients with simple uninvestigated dyspepsia.6–9 Specifically , patients younger than 45 with dyspepsia6,8 and without “ alarm ” symptoms ( bleeding , weight loss , dysphagia , anorexia , vomiting ) should be tested for H. pylori and , if positive , receive a 10to 14-day course of eradication therapy . If symptoms fail to improve with treatment , then diagnostic upper endoscopy should be performed . Despite evidence in support of this approach,5 several prospect i ve trials have cast uncertainty regarding the effectiveness of “ test- and -treat ” for dyspepsia.10–13 For example , 1 recent high- quality r and omized control trial suggested that the test and treat strategy applied to the general population may provide symptomatic relief for only 5 % of patients and makes no appreciable impact on quality of life.10 These results may be explained in part by 4 advances in our underst and ing of H. pylori eradication BACKGROUND & AIMS The Rome III criteria for functional dyspepsia have been changed to include 2 distinct syndromes : postpr and ial distress syndrome and epigastric pain syndrome . We investigated risk factors for functional dyspepsia among the functional dyspepsia subgroups defined by the Rome III criteria . METHODS We performed a cross-sectional population -based study in a primary care setting ( the Kalix and a study ) . A r and om sample ( n = 2860 ) of the adult population from 2 northern Swedish municipalities ( n = 21,610 ) was surveyed using a vali date d postal question naire to assess gastrointestinal symptoms ( response rate , 74.2 % ; n = 2122 ) . A r and omly selected subgroup ( n = 1001 ) of responders was invited to undergo an esophagogastroduodenoscopy ( participation rate , 73.3 % ) including biopsy specimen collection , Helicobacter pylori culture and serology , and symptom assessment s. RESULTS Of the 1001 subjects examined by endoscopy , 202 ( 20.2 % ; 95 % confidence interval [ CI ] , 17.7 - 22.7 ) were classified as having uninvestigated dyspepsia and 157 ( 15.7 % ; 95 % CI , 13.4 - 18.0 ) as having functional dyspepsia . Major anxiety ( Hospital Anxiety and Depression Scale score > or = 11 ) was associated with uninvestigated dyspepsia ( odds ratio [ OR ] , 3.01 ; 95 % CI , 1.39 - 6.54 ) , as was obesity ( body mass index > or = 30 kg/m(2 ) ) ( OR , 1.86 ; 95 % CI , 1.15 - 3.01 ) . Major anxiety was associated with functional dyspepsia and postpr and ial distress syndrome ( OR of 2.56 [ 95 % CI , 1.06 - 6.19 ] and 4.35 [ 95 % CI , 1.81 - 10.46 ] , respectively ) , as was use of nonsteroidal anti-inflammatory drugs ( OR , 2.49 [ 95 % CI , 1.29 - 4.78 ] and 2.75 [ 95 % CI , 1.38 - 5.50 ] , respectively ) . Depression was not associated with any dyspepsia group . CONCLUSIONS Anxiety but not depression is linked to uninvestigated dyspepsia , functional dyspepsia , and postpr and ial distress syndrome but not to epigastric pain syndrome BACKGROUND The eradication rates of Helicobacter pylori ( H. pylori ) with st and ard treatments are decreasing worldwide as in Greece . Studies with new antibiotic combinations are needed to find better methods of eradication . Therefore , the aim of this study was to evaluate efficacy and tolerability of a 10-day , four-drug , three-antibiotic , nonbismuth-containing concomitant regimen . MATERIAL S AND METHODS This is a prospect i ve , open-label , multicenter study that included 131 patients infected with H. pylori . All patients were diagnosed with peptic ulcer disease or nonulcer dyspepsia by endoscopy . H. pylori infection was established by at least two positive tests among rapid urease test , gastric histology , and ( 13 ) C-urea breath test . For 10 days , all patients received esomeprazole 40 mg , amoxycillin 1000 mg , clarithromycin 500 mg , and metronidazole 500 mg , all b.d . eradication was assessed with ( 13 ) C urea breath test 8weeks after the start of treatment . Intention-to-treat and per- protocol eradication rates were determined . RESULTS One hundred and twenty-seven of the 131 patients completed the study . At intention-to-treat analysis , the eradication rate was 91.6 % ( 95 % confidence interval ( CI ) , 85.5 - 95.7 % ) . For the per- protocol analysis , the eradication rate was 94.5 % ( 95 % CI , 89 - 97.8 % ) . Adverse events were noted in 42 of 131 ( 32.1 % ) ; drug compliance was excellent with 96.9 % of the patients taking more than 90 % of the prescribed medication . CONCLUSION A 10-day concomitant regimen appears to be an effective , safe , and well-tolerated treatment option for first-line H. pylori eradication in Greece : The relationship between Helicobacter pylori infection and non‐ulcer dyspepsia is not established . Background : Although the ‘ test‐ and ‐treat ’ strategy is suggested as first‐line therapy for uninvestigated dyspepsia , no large‐scale studies in a real‐life setting are available . Methods : 1552 dyspeptic patients aged between 25 and 60 with no alarm symptoms were recruited to the study . After screening with a 13 C‐urea breath test , they were r and omized into three treatment arms : Helicobacter pylori‐positive either to eradication therapy with OAM ( omeprazole , amoxycillin and metronidazole ) ( Hp+/erad ) or omeprazole 20 mg daily ( Hp+/ome ) for 10 days , whereas H. pylori‐negative patients ( Hp−/ome ) were treated with 20 mg omeprazole for 10 days . Gastrointestinal symptoms were registered at baseline at 1 and 2 years on the Gastrointestinal Symptom Rating Scale ( GSRS ) and quality of life with the Psychological General Well‐Being index ( PGWB ) . Additional visits , referrals for and number of endoscopies and their findings were registered during the 2 years ' follow‐up . Results : Of the 1552 patients , 583 were H. pylori‐positive ( 37.6 % ) , and 288 of these were r and omized for omeprazole and 295 to OAM . The Hp−/ome group had fewer general practitioner ( GP ) contacts ( P < 0.0001 ) than the H. pylori‐positive groups . Eradication therapy significantly improved general well‐being and reduced upper gastrointestinal symptoms : abdominal pain ( P = 0.0001 ) , heartburn ( P = 0.0061 ) , acid regurgitation ( P = 0.003 ) , hunger pain ( P = 0.009 ) , especially in Hp+/erad . Peptic ulcer was found in 6.2 % , 1.0 % , 0.2 % in Hp+/ome , Hp−+/erad and Hp−/ome , respectively ( P = 0.0007 ) . Only 3 patients ( 1.0 % ) developed peptic ulcers in Hp−+/erad , all eradication failures . Conclusions : In uninvestigated dyspepsia , a negative test result for H. pylori reduces the number of GP contacts and endoscopy referrals compared to H. pylori‐positive regardless of eradication therapy . Applied in real life , the test‐ and ‐treat strategy failed to reduce the number of endoscopies , but significantly reduced peptic ulcer disease and improved dyspeptic symptoms and quality of life Gastritis caused byHelicobacter pylori ( HP ) is common in patients with nonulcer dyspepsia ( NUD ) , but an etiologic relationship between the histologic lesion and clinical symptoms is unproven . HP is inhibited by bismuth subsalicylate ( BSS ) , a traditional remedy for dyspeptic complaints . The aim of this study was to assess the short- and long-term effects of BSS on HP , gastritis , and symptoms in patients with NUD . One hundred twenty-six patients with NUD who were shown to be infected withH. pylori ( HP+ ) were enrolled . There was a two-week placebo run-in period to eliminate placebo responders . Fifty patients remained symptomatic and were r and omly assigned to therapy with either BSS liquid or a matching placebo .  EGD , biopsy , and clinical evaluations were performed at entry , at week 5 ( end of therapy ) , at week 9 ( four weeks after therapy ) , or at time of symptomatic relapse . Twenty-seven patients received placebo and 23 patients received BSS . BSS  suppressedH. pylori in 15/23 patients ( 65 % ) and eradicated it in one patient , whereas the placebo had no effect onH. pylori . Gastritis improved during therapy with BSS but relapsed by week 9 . There was no significant change in level of dyspeptic symptoms during or after treatment , although one month after the end of treatment , the patients in the BSS group consistently had lower symptom scores and fewer symptomatic days for all symptoms measured . The study confirms that BSS given for three weeks suppresses but does not usually eradicateH. pylori . Such short-term suppression ofH. pylori heals gastritis but does not result in clinical improvement Although the eradication of Helicobacter pylori infection benefits patients with gastric or duodenal ulcers , the value of eradicating the infection in the patients with functional dyspepsia ( FD ) remains controversial This study aim ed to test whether pretreatment gastric pathology in H. pylori-infected nonulcer dyspepsia ( HpNUD ) patients is relevant to and predictive of the symptomatic response after H. pylori eradication . Anti-H. pylori triple therapy was administered to 250 HpNUD patients , enrolled as the therapy group . In addition , 60 patients were enrolled as the control group , in which omeprazole was an alternatives to the triple therapy . Pretreatment gastric histology was evaluated thoroughly by the up date d Sydney system . A [ 13C ] urea breath test was also performed to evaluate the H. pylori eradication two months and 12 months later . For each patient , the baseline , month 2 , and month 12 symptom scores were assessed for the month 2 or month 12 residual symptom ratio ( RSR-2 m or RSR-12 m ) , calculated from : 100 % × month 2 or month 12 score/baseline score . Based on either RSR-2 m or RSR-12 m , patients were categorized as good response ( RSR < 50 % ) , moderate response ( 50–70 % ) , and poor response ( > 70 % ) subgroups in both therapy and control groups to define the short-term and long-term symptomatic responses . Patients with successful H. pylori eradication in the therapy group showed a higher incidence of good symptomatic response ( RSR < 50 % ) than those from the control group ( month 2 : 30.3 vs 12 % , P < 0.05 ; month 12 : 34.7 vs 17.1 % , P < 0.05 ) . Univariate and multivariate analysis disclosed that patients with a higher acute inflammation score ( AIS ) and the lowest incidence of lymphoid follicles ( LF ) at pretreatment gastric histology are predisposed to having a good symptom response after H. pylori eradication ( P < 0.05 ) . For HpNUD patients who have an AIS of more than three and an absence of LF at gastric histology , more than 85 % had good short-term ( month 2 ) and long-term ( month 12 ) symptomatic relief after H. pylori eradication . In conclusion , nearly 30 % of HpNUD patients can obtain symptomatic relief following H. pylori eradication . The pretreatment gastric histology of HpNUD can be helpful to monitor the symptomatic response after H. pylori eradication 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 Fifty-three patients with previously uninvestigated chronic dyspepsia symptoms in the absence of gastrointestinal or extra-gastrointestinal disease ( functional dyspepsia ) underwent antral and duodenal mucosal biopsies to detect the role of such samplings in the presence of normal endoscopic findings . Patients were enrolled in a r and omized , placebo-controlled , double-blind trial , receiving either eradicating treatment ( colloidal bismuth subcitrate plus metronidazole ) or placebo if they had Helicobacter pylori-associated gastritis ( 20 patients ) , or cisapride or placebo if they had normal antral mucosa ( 28 cases ) . Unsuspected celiac sprue was found in one patient . Eradicating treatment ameliorated histological gastritis ( p = 0.01 ) . However , owing to great placebo efficacy , symptom remission rates following a 1-month wash-out period in both treatment groups were no higher than that in controls . Independent of the initial r and omization , an extremely low symptom recurrence rate was observed during a drug-free follow-up study equivalent to the mean duration of symptoms before enrollment . We conclude that in functional dyspepsia , bulbar and antral biopsies are not useful in clinical management , equivalent symptom relief can be achieved in patients r and omly assigned to both drugs and placebos , and such improvement can be long lasting in the absence of any maintenance treatment . We believe the prevalence of unsuspected villous atrophy and the therapeutic role of investigation-based reassurance deserve further assessment 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 Abstract Objective : To evaluate the performance of a near patient test for Helicobacter pylori infection in primary care . Design : Validation study performed within a r and omised trial of four management strategies for dyspepsia . Setting : 43 general practice s around Nottingham . Subjects : 394 patients aged 18 - 70 years presenting with recent onset dyspepsia . Main outcome measures : Results of the Flex Sure test compared with an enzyme linked immunosorbent assay ( ELISA ; HM-CAP ) with an identical antigen profile and with results of an earlier validation study in secondary care Diagnostic yield of patients undergoing endoscopy on the basis of their Flex Sure result compared with those of patients referred directly for endoscopy . Results : When used in primary care Flex Sure test had a sensitivity and specificity of 67 % ( 95 % confidence interval 59 % to 75 % ) and 98 % ( 95 % to 99 % ) compared with a sensitivity and specificity of 92 % ( 87 % to 97 % ) and 90 % ( 83 % to 97 % ) when used previously in secondary care . Of the H pylori test and refer group 14 % ( 28/199 ) were found to have conditions for which H pylori eradication was appropriate compared with 23 % ( 39/170 ) of the group referred directly for endoscopy . Conclusions : When used in primary care the sensitivity of the Flex Sure test was significantly poorer than in secondary care About a third of patients who would have benefited from H pylori eradication were not detected . Near patient tests need to be vali date d in primary care before they are incorporated into management policies for dyspepsia . Key messages Near patient tests for H pylori infection have been recommended in the management of dyspepsia in primary care without proper evaluation Such tests should have a high sensitivity to avoid missing treatable illness related to infection The Flex Sure near patient test had a lower sensitivity than previously reported in validation studies performed in secondary care Fewer than expected numbers of patients with H pylori related pathology were identified with the Flex Sure in primary Objectives : We sought to examine the extent to which physicians recognize H. pylori as a causal agent in peptic ulcer disease or as a potential cofactor in other gastrointestinal diseases , and to observe how this knowledge has influenced diagnostic and therapeutic practice s. Methods : We used a national mail survey in the U.S. between February and May of 1996 , querying 5994 U.S. physicians ( family/general practitioners [ FPs ] , internists [ IMs ] , and gastroenterologists ) selected at r and om from three different membership data bases of professional associations . Results : The response rate was 52 % . More than 95 % of physicians who treat symptoms empirically would prescribe acid suppressant therapy rather than anti-H. pylori therapy . Between 43 % and 66 % of physicians , varying in frequency by medical specialty , would treat the infection in H. pylori-positive patients with nonulcer dyspepsia . In confirmed peptic ulcer disease , between 88 % and 100 % of physicians would treat the H. pylori infection , depending on the physician group and whether or not the presentation of an ulcer was recurrent . Although 103 distinct anti-H. pylori regimens were reported , 89 % of the gastroenterologists and 70 % of the primary care physicians ( PCPs ) used combinations of antimicrobials with reported cure rates of at least 80 % . Conclusions : General knowledge regarding H. pylori-associated diseases was widespread among primary care physicians and gastroenterologists . However , anti-H. pylori therapies judged ineffective were reported as the first choice regimen by 5 % of gastroenterologists and 18 % of primary care physicians . Gastroenterologists appear to implement the latest scientific developments in the field rapidly whereas PCPs manifest a delayed response , due to either insufficient knowledge or to other factors influencing their approach to treatment We have carried out a double blind placebo controlled trial to assess the effects of treatment with colloidal bismuth subcitrate in Helicobacter pylori associated non-ulcer dyspepsia . Eighty patients with dyspepsia , normal upper gastrointestinal appearances at endoscopy and H pylori associated active chronic gastritis on histology of gastric antral biopsies were included in the trial . The patients were r and omised to receive colloidal bismuth subcitrate 240 mg twice daily for four weeks or matching placebo and were reassessed four weeks after completing treatment . Twenty-six patients ( 67 % ) receiving colloidal bismuth subcitrate had normal histology or improved inflammation compared with five ( 13 % ) receiving placebo ( p less than 0.001 ) , and symptoms were absent or improved in 32 ( 82 % ) and two ( 5 % ) respectively ( p less than 0.001 ) . Serum IgG level was a marker of infection , and fell with successful treatment . Colloidal bismuth subcitrate is effective treatment for H pylori associated non-ulcer dyspepsia with improved gastric antral histological appearances and has a beneficial effect on symptoms
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 .