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Limited Effect of H. pylori Eradication in Dyspeptic Patients

In patients who did not have ulcers, eradication of H. pylori infections did not relieve dyspepsia or reduce medication costs.

In several studies of patients with nonulcer dyspepsia, eradication of Helicobacter pylori has yielded little benefit. Results of 2 new studies add to the literature.

In a multicenter study, Canadian researchers enrolled 157 patients with chronic or frequent epigastric pain, no endoscopic evidence of peptic ulcer, and positive urease and breath tests for H. pylori infection. Patients were randomized to receive either H. pylori eradication therapy or placebo; the eradication rate was 82% in the actively treated group. During 1 year of follow-up, no significant differences between groups were noted in dyspepsia scores, proportions of patients with improved symptoms, or use of acid-reducing medications.

In another study, Seattle researchers enrolled 432 patients who used H₂-blockers or proton-pump inhibitors (according to a pharmacy database), tested positive (serologically) for H. pylori infection, and reported histories of dyspepsia or previous peptic ulcer but not reflux alone. All patients received H. pylori eradication therapy. During the year after eradication, medication costs and total costs related to gastrointestinal disease were not reduced significantly compared with those during the previous year. However, in a small subgroup of patients who had previously documented peptic ulcer and no reflux symptoms and who had received chronic acid-suppressive therapy, eradication therapy reduced medication costs.

Comment: These findings reinforce previous research that suggested that H. pylori eradication did not relieve dyspepsia if peptic ulcer had been excluded by endoscopy. However, some uninvestigated patients who are H. pylori positive have previously documented ulcers or active but undiagnosed ulcers: Eradication therapy could be beneficial in such patients.

— Allan S. Brett, MD

Published in Journal Watch General Medicine October 17, 2003

Citation(s):

Veldhuyzen van Zanten S et al. Absence of symptomatic benefit of lansoprazole, clarithromycin, and amoxicillin triple therapy in eradication of Helicobacter pylori positive, functional (nonulcer) dyspepsia. Am J Gastroenterol 2003 Sep; 98:1963-9.

• Medline abstract (Free)

Kearney DJ et al. The effect of a Helicobacter pylori treatment strategy on health care expenditures in patients with peptic ulcer disease and dyspepsia. Am J Gastroenterol 2003 Sep; 98:1952-62.

• Medline abstract (Free)