The role of Helicobacter pylori infection in functional dyspepsia

Eradication of Helicobacter pylori (H. pylori) in patients with functional dyspepsia (FD) continues to be a matter of debate. A recent study [1] examined Helicobacter pylori eradication effects on symptoms and quality of life (QoL) of primary care patients. H. pylori-positive adult patients with FD who met the Rome III International Consensus criteria, were randomly assigned to receive omeprazole, amoxicillin trihydrate, and clarithromycin, or omeprazole plus placebo for 10 days. Endoscopy and H. pylori tests were performed at screening and at 12 months. Outcome measures were at least 50% symptomatic improvement at 12 months, using a validated disease-specific questionnaire (primary endpoint), patient global assessment of symptoms and QoL. 404 patients (78.7% women; mean age, 46.1 years) were randomly assigned; 201 were assigned to be treated with antibiotics (antibiotics group) and 203 to a control group. A total of 389 patients (96.3%) completed the study. The proportion of patients who achieved the primary outcome was 49.0% (94 of 192) in the antibiotics group and 36.5% (72 of 197) in the control group [p=0.01; number needed to treat (NNT), 8]. In the overall symptoms patient assessment, 78.1% in the antibiotics group (157/201) answered that they were better symptomatically, and 67.5% in the control group (137/203) said that they were better (P=0.02). The antibiotics group had a significantly larger increase in mean (SD) outcomes of the 36-item SFHSPC (Short Form Health Survey Physical Component) summary scores than the control group (4.15 [8.5] vs. 2.2 [8.1]; p=0.02). The conclusion of the study was that H. pylori eradication provided significant benefits to primary care patients with FD.