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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.
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