 |
|
Lack of Effect of Treatment for Helicobacter pylori on Symptoms of Nonulcer Dyspepsia
Paul D. Greenberg, MD;
John P. Cello, MD
Arch Intern Med. 1999;159:2283-2288.
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 randomized, 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 randomized 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.
From the Division of Gastroenterology, Hepatology, and Clinical Nutrition, Medical Service, San Francisco General Hospital , and the Department of Medicine, University of California, San Francisco (Drs Greenberg and Cello). Dr Greenberg is now with Merck-Medco Managed Care, Franklin Lakes, NJ.
RELATED LETTER
Nonulcer Dyspepsia and Helicobacter pylori Infection
Giovanni Cammarota, Rossella Cianci, Giovanni Gasbarrini, and Paul D. Greenberg
Arch Intern Med. 2000;160(14):2225-2226.
EXTRACT
| FULL TEXT
RELATED ARTICLE
Archives of Internal Medicine Reader's Choice: Continuing Medical Education
Arch Intern Med. 1999;159(19):2369-2370.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
The Relationship among Previous Antimicrobial Use, Antimicrobial Resistance, and Treatment Outcomes for Helicobacter pylori Infections
McMahon et al.
ANN INTERN MED 2003;139:463-469.
ABSTRACT
| FULL TEXT
A rational approach to uninvestigated dyspepsia in primary care: review of the literature
Arents et al.
Postgrad. Med. J. 2002;78:707-716.
ABSTRACT
| FULL TEXT
Protagonist: Should we eradicate Helicobacter pylori in non-ulcer dyspepsia?
McColl
Gut 2001;48:759-761.
FULL TEXT
Systematic review and economic evaluation of Helicobacter pylori eradication treatment for non-ulcer dyspepsia
Moayyedi et al.
BMJ 2000;321:659-664.
ABSTRACT
| FULL TEXT
Update in General Internal Medicine
Roach et al.
ANN INTERN MED 2000;133:209-217.
FULL TEXT
Nonulcer Dyspepsia and Helicobacter pylori Infection
Cammarota et al.
Arch Intern Med 2000;160:2225-2226.
FULL TEXT
Absence of Benefit of Eradicating Helicobacter pylori in Patients with Nonulcer Dyspepsia
McColl et al.
NEJM 2000;342:589-590.
FULL TEXT
|
