Investigation into whether eradication of H pylori improves the symptoms associated with functional dyspepsia has provided interesting results. In a large, multicentre study conducted by Blum and colleagues, 328 patients with functional dyspepsia and confirmed infection with H pylori were randomly assigned to receive one week of eradication therapy with a PPI plus amoxicillin and clarithromycin, or one week of treatment with a PPI alone. Although the proportion of patients without gastritis was significantly higher in the patients treated with eradication therapy than in those treated with a PPI alone (75.0% versus 3.0%, respectively; P<0.001), treatment success, defined by the overall relief of dyspeptic symptoms, was similar between the groups (27.4% versus 20.7%, respectively; P=0.17). Thus, at one year, dyspeptic symptoms had resolved in 6.7% more patients treated with eradication therapy than in those treated with a PPI alone. In contrast, in a single-centre study conducted by McColl and colleagues, 21% of patients with functional dyspepsia and infection with H pylori who were treated with two weeks of eradication therapy (PPI plus amoxicillin and metronidazole) experienced resolution of dyspeptic symptoms compared with 7% of those who were treated with a PPI alone (P<0.001). Overall, 14% more patients treated with eradication therapy had resolution of dyspeptic symptoms than those treated with a PPI alone. A combination of the results from these two trials suggests that a 10% increase in improvement of dyspeptic symptoms occurs with eradication therapy compared with treatment with a PPI alone. This is similar to the improvement that was observed in H pylori-positive patients with functional dyspepsia who were treated with PPIs in a large study that compared the efficacy of PPIs with that of placebo (Figure 1).
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Figure 1) The effect of eradication of Helicobacter pylori on symptoms of functional dyspepsia. ET Eradication therapy; PPI Proton pump inhibitor.
The role of H pylori in functional dyspepsia remains controversial; however, a subset of patients with functional dyspepsia appear to benefit from eradication therapy. Thus, the current Canadian Consensus Guidelines recommend that patients less than 45 years of age with uninvestigated dyspepsia who have had dyspeptic symptoms for more than three months but do not have alarm symptoms or features should be tested and treated for infection with H pylori.