Dyspeptic Symptoms Associated With Helicobacter pylori Infection
Dyspeptic Symptoms Associated With Helicobacter pylori Infection
Background: Dyspepsia can be associated with H. pylori infection.
Aim: To assess dyspeptic symptoms and potentially influencing factors before and up to 6 months following successful H. pylori eradication therapy.
Methods: Prospective cohort study involving H. pylori positive subjects from ambulatory or hospitalized care. Main outcome measures were symptoms during baseline and follow-up, the proportion of symptom-free patients, and symptom scores.
Results: After successful eradication, the summary score of all dyspeptic symptoms decreased and during follow-up, the proportion of symptom-free patients was higher in the group with peptic ulcers (69.4% vs. 40.9%, P < 0.0001) than with functional dyspepsia (FD).
Regardless of diagnosis, virulent strains of H. pylori were associated with a higher prevalence of epigastric pain before treatment: absolute risk-difference (ARD) with Oip-A: 18.2%, Odds Ratio (OR) 2.35 [1.3-4.2, 95%-CI], P = 0.01; with Cag-A: 24.6%, OR 2.81 [1.6-5], P = 0.01. Low-dose aspirin in part was a major risk factor in FD for previous weight loss bdfore study entry. Post-treatment, non-ulcer patients were more likely to suffer from distention/bloating. Likewise, alcohol induced persistence of nausea and vomiting in this population.
Conclusions: Dyspeptic symptoms in H. pylori infected patients are more common with virulent strains. Symptoms are more likely to persist despite successful eradication if patients initially harboured virulent strains or concomitant aspirin or alcohol intake are present. In one-third of peptic ulcer patients, symptoms will not be cured 3 months after therapy.
Functional dyspepsia is a poorly defined disease entity despite the criteria given by the Rome II classification in 1999. The prevalence of functional dyspepsia is high within the Western European population and the economic impact is usually underestimated. Apart from ulcer-like and dysmotility-like symptoms, it may be difficult to separate the overlap features of irritable bowel syndrome or gastro-oesophageal reflux disease, which are sometimes summarized as unspecified dyspepsia. Functional dyspepsia requires at least the exclusion of peptic ulcer disease (PUD), but endoscopic findings cannot usually be predicted from the clinical presentation or symptoms. Therapy for functional dyspepsia is empirical and several approaches have been attempted, including acid-suppressive drugs, such as proton pump inhibitors and antacids, prokinetic drugs and newer approaches, such as 5-hydroxytryptamine-3 receptor antagonists. Compared with placebo, all of these drugs have been shown to improve symptoms only in a minority of patients (up to 25%) and only as long as they are given, which results in symptomatic relapse after drug withdrawal in the majority of patients. Some patients suffering from functional dyspepsia are infected with Helicobacter pylori and the concept of short-term medical intervention (eradication therapy) is very attractive. Various epidemiological studies linking H. pylori infection and functional dyspepsia have revealed conflicting results. Former and more recent meta-analyses of major prospective randomized controlled intervention trials have concluded that, if at all, only a small subset of patients (up to 10%) may benefit from H. pylori eradication in the long term. Dyspeptic symptoms, however, can occur in patients with PUD as well as in those with functional dyspepsia, and concerning the latter one, different background prevalence rates of PUD and different likelihoods of future PUD development may account, in part, for the conflicting results obtained formerly. Strain- and host-specific factors have been poorly evaluated by previous studies, and co-factors, such as alcohol or drug [aspirin, non-steroidal anti-inflammatory drugs (NSAIDs)] intake and smoking status, have either been insufficiently documented or not restricted to a necessary extent. Studies evaluating H. pylori virulence factors, such as Cag-A, in association with functional dyspepsia have been analysed retrospectively, have been under-powered to address this question or have not evaluated co-factors in a multivariate analysis.
Therefore, the main objective of this prospective study was to investigate the possible relationship between influencing factors, which were evaluated at baseline and were linked either to the patient (host) or the bacterium, and dyspeptic symptoms. Symptoms were assessed in terms of intensity and characteristic features before and during a 6-month period following successful H. pylori eradication. To avoid a possible selection bias, we did not restrict our analysis to patients with an actual presentation of functional dyspepsia, but also included patients with past or present PUD.
Background: Dyspepsia can be associated with H. pylori infection.
Aim: To assess dyspeptic symptoms and potentially influencing factors before and up to 6 months following successful H. pylori eradication therapy.
Methods: Prospective cohort study involving H. pylori positive subjects from ambulatory or hospitalized care. Main outcome measures were symptoms during baseline and follow-up, the proportion of symptom-free patients, and symptom scores.
Results: After successful eradication, the summary score of all dyspeptic symptoms decreased and during follow-up, the proportion of symptom-free patients was higher in the group with peptic ulcers (69.4% vs. 40.9%, P < 0.0001) than with functional dyspepsia (FD).
Regardless of diagnosis, virulent strains of H. pylori were associated with a higher prevalence of epigastric pain before treatment: absolute risk-difference (ARD) with Oip-A: 18.2%, Odds Ratio (OR) 2.35 [1.3-4.2, 95%-CI], P = 0.01; with Cag-A: 24.6%, OR 2.81 [1.6-5], P = 0.01. Low-dose aspirin in part was a major risk factor in FD for previous weight loss bdfore study entry. Post-treatment, non-ulcer patients were more likely to suffer from distention/bloating. Likewise, alcohol induced persistence of nausea and vomiting in this population.
Conclusions: Dyspeptic symptoms in H. pylori infected patients are more common with virulent strains. Symptoms are more likely to persist despite successful eradication if patients initially harboured virulent strains or concomitant aspirin or alcohol intake are present. In one-third of peptic ulcer patients, symptoms will not be cured 3 months after therapy.
Functional dyspepsia is a poorly defined disease entity despite the criteria given by the Rome II classification in 1999. The prevalence of functional dyspepsia is high within the Western European population and the economic impact is usually underestimated. Apart from ulcer-like and dysmotility-like symptoms, it may be difficult to separate the overlap features of irritable bowel syndrome or gastro-oesophageal reflux disease, which are sometimes summarized as unspecified dyspepsia. Functional dyspepsia requires at least the exclusion of peptic ulcer disease (PUD), but endoscopic findings cannot usually be predicted from the clinical presentation or symptoms. Therapy for functional dyspepsia is empirical and several approaches have been attempted, including acid-suppressive drugs, such as proton pump inhibitors and antacids, prokinetic drugs and newer approaches, such as 5-hydroxytryptamine-3 receptor antagonists. Compared with placebo, all of these drugs have been shown to improve symptoms only in a minority of patients (up to 25%) and only as long as they are given, which results in symptomatic relapse after drug withdrawal in the majority of patients. Some patients suffering from functional dyspepsia are infected with Helicobacter pylori and the concept of short-term medical intervention (eradication therapy) is very attractive. Various epidemiological studies linking H. pylori infection and functional dyspepsia have revealed conflicting results. Former and more recent meta-analyses of major prospective randomized controlled intervention trials have concluded that, if at all, only a small subset of patients (up to 10%) may benefit from H. pylori eradication in the long term. Dyspeptic symptoms, however, can occur in patients with PUD as well as in those with functional dyspepsia, and concerning the latter one, different background prevalence rates of PUD and different likelihoods of future PUD development may account, in part, for the conflicting results obtained formerly. Strain- and host-specific factors have been poorly evaluated by previous studies, and co-factors, such as alcohol or drug [aspirin, non-steroidal anti-inflammatory drugs (NSAIDs)] intake and smoking status, have either been insufficiently documented or not restricted to a necessary extent. Studies evaluating H. pylori virulence factors, such as Cag-A, in association with functional dyspepsia have been analysed retrospectively, have been under-powered to address this question or have not evaluated co-factors in a multivariate analysis.
Therefore, the main objective of this prospective study was to investigate the possible relationship between influencing factors, which were evaluated at baseline and were linked either to the patient (host) or the bacterium, and dyspeptic symptoms. Symptoms were assessed in terms of intensity and characteristic features before and during a 6-month period following successful H. pylori eradication. To avoid a possible selection bias, we did not restrict our analysis to patients with an actual presentation of functional dyspepsia, but also included patients with past or present PUD.
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