Evaluation of dyspeptic symptoms in patients with and without Helicobacter pylori infection and normal upper gastrointestinal endoscopy

BACKGROUND: A relationship between Helicobacter pylori infection and dyspeptic symptoms has not yet been demonstrated. AIM: To evaluate any possible difference in symptom score between dyspeptic patients with and without H. pylori infection who have normal upper gastrointestinal endoscopy and no other appreciable gastrointestinal or systemic disease. PATIENTS: A series of consecutive patients affected by upper abdominal disturbances completed a symptoms questionnaire before undergoing upper gastrointestinal endoscopy with a rapid urease test to detect H. pylori infection. Patients with normal upper gastrointestinal endoscopy and abdominal ultrasound were included in the study. The symptoms assessed were burping and belching, bloating, odynophagia, dysphagia, postprandial fullness, heartburn, early satiety, nausea, vomiting, regurgitation, sour taste in mouth, epigastric pain at fasting, epigastric pain postprandial, epigastric pain nocturnal, and pain in right hypocondrium and were scored in terms of intensity and frequency on a scale from 0 to 4. RESULTS: The total number of patients who met the inclusion criteria was 263 out of 1187 examined. A total of 113 H. pylori-positive and 150 H. pylori-negative patients were compared. Among the symptoms evaluated, belching and bloating and heartburn were present in more than 50% of patients of both groups. No statistical difference was found in terms of presence or absence of each symptom, and intensity or frequency between H. pylori-positive and -negative patients. CONCLUSION: H. pylori infection does not seem to be associated with a specific symptom in patients with upper abdominal complaints and normal upper gastrointestinal endoscopy.     

Improvement of gastrointestinal quality of life scores in cases of Helicobacter pylori-positive functional dyspepsia after successful eradication therapy

Functional dyspepsia (FD) refers to a broad range of chronic upper abdominal symptoms associated with food intake. A definitive treatment for FD has not yet been established, and the effect of Helicobacter pylori (H. pylori) eradication still remains under debate. The Gastrointestinal Symptom Rating Scale (GSRS) is a specific questionnaire for patients with gastrointestinal symptoms. The present study examined the quality of life (QOL) of patients with H. pylori-positive FD following H. pylori eradication. Methods: Sixty-eight patients with FD who gave informed consent were recruited for the study. H. pylori infection was diagnosed by the culture and histological methods, and the H. pylori eradication consisted of a 7-day course of lansoprazole, amoxicillin and clarithromycin. The overall success of the treatment was confirmed by a 13C urea breath test (UBT) conducted 3 months after the eradication. The GSRS questionnaire was administered to the patient just before the start of the eradication therapy and at 3 months after the therapy, just before the UBT was performed. Results: In successfully eradicated patients, the total GSRS and the abdominal pain score significantly decreased. In particular, the abdominal pain score and indigestion score were significantly decreased after successful eradication in patients with ulcer-like FD or dysmotility-like FD. Conversely, in patients in whom the eradication was unsuccessful, neither the total GSRS nor any of the individual symptom scores showed any significant change. Conclusion: Successful H. pylori eradication improved the QOL of patients with FD, in particular H. pylori-positive patients with ulcer-like FD or dysmotility-like FD.     

Co-existence of Helicobacter pylori infection in patients with Familial Mediterranean Fever (FMF) and the effect of Helicobacter pylori on the frequency and severity of FMF attacks

BACKGROUND: The inflammatory reactions both in Familial Mediterranean Fever and in Helicobacter pylori infection have similarities. Whether there is interactions in case of co-existence of both diseases has not been evaluated. AIM.: To evaluate, if there is a significant relation between H. pylori infection and Familial Mediterranean Fever; if H. pylori has an effect on the frequency and severity of Familial Mediterranean Fever attacks; and if eradication treatment has any affects. METHODS: Thirty-two Familial Mediterranean Fever patients were tested for H. pylori infection. Acute phase responses were evaluated and attack frequency and severity were determined in both H. pylori-positive and H. pylori-negative groups. Same determinations were done after the eradication treatment in H. pylori-positive patients. Levels of acute phase determinants as well as frequency and severity of attacks were compared in H. pylori-positive and -negative groups. RESULTS: C-reactive protein, erythrocyte sedimentation rate, white blood count and fibrinogen levels were significantly (p<0.01) higher during the attacks than before the attacks in all patients. However, there was no difference between the groups. H. pylori-positive patients have a higher frequency and a longer duration of attacks when compared to H. pylori-negative patients before treatment (p<0.05). The frequency was also significantly lower and duration was shorter in patients whose infections were eradicated (p<0.05). CONCLUSION: H. pylori infection was not significantly frequent in our group of Familial Mediterranean Fever patients. H. pylori can decrease both the frequency and the duration of the attacks. Studies that will evaluate the relationship of H. pylori and MEFV gene along with the roles of yet unknown cytokines, which can presumably play a role in the pathogenesis of both diseases, are needed to reach better conclusions.     

Helicobacter pylori colonization does not influence the symptomatic response to prokinetic agents in patients with functional dyspepsia

Functional dyspepsia (FD) is very common, but the pathogenesis of Helicobacter pylori leading to FD is still debated. The aim of this study was first to evaluate the impact of H. pylori colonization on the efficacy of Paspertase® (a metoclopramide plus exogenous enzymes regimen for FD patients) and, second, to compare the prevalence of H. pylori infection in FD patients with the general population. Seventy-four consecutive FD patients were enrolled undergoing Paspertase® treatment. The symptomatic response was evaluated according to 1–4 scales of six main dyspeptic symptoms (i.e. epigastric pain/discomfort, early satiety, heartburn, nausea/vomiting, abdominal fullness/bloating, and belching). Nine hundred and seventy healthy subjects undergoing a paid physical check-up were included to study the status of H. pylori colonization. The demographic data and basal symptom scores between 43 H. pylori -positive and 31 H. pylori -negative patients were not significantly different. Total and individual symptom scores improved significantly after 4 weeks of Paspertase® therapy ( P < 0.05), irrespective of H. pylori infection. The prevalences of H. pylori were very similar in FD patients and the general population (58.1 vs 58.0%, NS). In conclusion, these observations suggest that H. pylori colonization is not significant in FD patients of Taiwan while a short-term prokinetic medication is effective for these patients, irrespective of H. pylori status.     

Helicobacter pylori eradication and standardized 3-month omeprazole therapy in functional dyspepsia

OBJECTIVES: The role of Helicobacter pylori in functional dyspepsia remains unclear. This study evaluated the long term consequences for symptoms and quality of life in patients with H. pylori-positive functional dyspepsia after H. pylori eradication therapy with a standardized 3-month omeprazole treatment. METHODS: A total of 151 H. pylori-positive patients with functional dyspepsia were randomized to receive either eradication therapy or placebo-antibiotics. The initial medication was administered in a double-blinded fashion. In addition, to standardize acid suppression, every patient received omeprazole therapy for the first 3-month period. Dyspeptic symptoms were evaluated by a questionnaire every 3 months, and quality of life was measured by a validated RAND 36-item health survey 1.0 questionnaire at the beginning of the study and after 12 months of follow-up. As the main outcome measure, the scores of patients who had received H. pylori eradication therapy and omeprazole were compared with those who received placebo and omeprazole during the 12 months of follow-up. RESULTS: A total of 136 patients completed the 1-yr follow-up. In all, 77 patients received eradication therapy and 74 patients remained as controls. After 12 months, the mean reduction in the dyspepsia score was 28.8% in patients with H. pylori eradication therapy and 21.7% in the control group. The reduction of dyspepsia was significant (p < 0.0001) in both groups compared to baseline value, but no statistically significant differences in changes of dyspeptic symptoms or in quality of life were demonstrated between the H. pylori eradication therapy group and controls after 1 yr. In both patient groups, regurgitation (p < 0.001) and heartburn (p < 0.01) revealed relapse after cessation of 3-month omeprazole treatment. CONCLUSIONS: No clear differences in symptoms or in quality of life were found between patients treated with H. pylori eradication therapy and omeprazole compared with patients receiving placebo and omeprazole after 1 yr. Regardless of H. pylori status, omeprazole treatment reduced heartburn and regurgitation. The placebo effect on the symptoms of functional dyspepsia and on quality of life was marked.     

Functional dyspepsia is associated with cagA-positive Helicobacter pylori strains

BACKGROUND: The antigen CagA can be used as a marker for virulence of Helicobacter pylori. It is tempting to assume that H. pylori strains positive for cytotoxin-associated gene A (cagA) could be responsible for functional dyspepsia. A cross-sectional study was performed in patients presenting with functional dyspepsia to correlate the clinical presentation with the presence of cagA-positive and -negative H. pylori strains. METHODS: Consecutive patients referred for endoscopy were studied. An inclusion criterion was the absence of any endoscopic abnormality. Biopsy specimens were obtained from the gastric antrum for HE and immunoperoxidase stain, rapid urease test, and culture. A serum sample was taken for detection of IgG antibodies against H. pylori as well as CagA. A validated questionnaire of 14 questions regarding the upper gastrointestinal tract was used for assessment of the clinical presentation. Nine questions were scored on a 5-point Likert scale. RESULTS: 422 patients were included, 222 were H. pylori-positive, the remaining 200 were H. pylori-negative. Mean symptom score in patients with cagA-positive strains was significantly higher than in patients with cagA-negative strains. No difference was present if cagA-negative patients were compared with H. pylori-negative dyspeptics. Four different complaints were more prevalent in the cagA-positive patients compared with cagA-negatives. When cagA-positive patients were compared with H. pylori-negative dyspeptics, seven complaints were significantly more prevalent in cagA-positives; when cagA-negatives were compared this number was only two. CONCLUSIONS: Functional dyspeptics with cagA-positive H. pylori strains have more dyspeptic symptoms and higher symptom scores than patients with cagA-negative H. pylori strains as well as H. pylori-negative functional dyspeptics.     

Effect of Helicobacter pylori Infection on Gastric Emptying and Gastrointestinal Hormones in Dyspeptic and Healthy Subjects

There is no general agreement as regards the effect of Helicobacter pylori infection on gastric emptying in patients with functional dyspepsia. Food releases several gastrointestinal hormones, and some of these are known to contribute to the regulation of gastric emptying. The aim of this study was to investigate the influence of H. pylori on gastric emptying in dyspeptic and healthy subjects and to verify whether different hormone secretion patterns are affected by the presence of the bacterium. Twenty-seven patients affected by functional dyspepsia and 30 asymptomatic healthy subjects entered the study. H. pylori presence was assessed in controls by IgG antibodies to H. pylori and [¹³C] urea breath test, and that in patients by Warthin-Starry stain on gastric biopsies. After ingesting a standard solid-liquid meal, an ultrasound examination of gastric emptying was performed. Plasma concentrations of gastrin, cholecystokinin, and pancreatic polypeptide were measured in the fasting and postprandial period for 4 hours. The incidence of H. pylori infection was not higher in functional dyspepsia patients than in controls. As regards gastric emptying, no difference was detected between patients and controls with and without H. pylori infection. On the contrary, the presence of H. pylori infection determined alterations in gastrin levels, which were higher in controls than in patients. Basal CCK levels were higher in the H. pylori-negative patients than H. pylori-positive patients and controls. In conclusion, H. pylori infection seems not to cause alterations in gastric emptying, but rather alterations in gastrin levels. In contrast, the altered levels of CCK account for its involvement in the pathophysiology of H. pylori-negative dyspepsia.     

Does Helicobacter pylori infection affect gastric emptying in patients with functional dyspepsia?

The objectives of the study were first, to determine if gastric emptying was altered in patients with functional dyspepsia with and without Helicobacter pylori infection compared with normal healthy volunteers; and second, to determine if there were further alterations in gastric emptying when the infection was eradicated. Gastric emptying was measured using a ^99mtechnetium radiolabelled solid meal and gastric emptying time was measured as t_1/2, viz. time taken for half the radiolabelled meal to be emptied from the stomach. The mean gastric emptying time for H. pylori-positive patients (n= 20) was 56.4±24.8 min; H. pylori-negative patients (n= 19) 67.8±31.8 min; and normal controls (n= 20) 58.8 ± 18.8 min. No significant difference was obtained between the groups (ANOVA; P= 0.348). Thirteen of 18 H. pylori-positive patients successfully eradicated the infection following treatment with omeprazole 40 mg o.m. and amoxycillin 500 mg t.d.s. for 2 weeks. The mean difference in the gastric emptying time before and H. pylori eradication was 23.9 + 13.2 min (P= 0.556). There was no significant difference in the frequency of specific dyspeptic symptoms as well as the overall mean symptom score between the H. pylori-positive and -negative patients. Gastric emptying was not different between patients with functional dyspepsia and normal controls. Helicobacter pylori infection does not appear to affect gastric emptying in patients with functional dyspepsia.     

Symptomatic benefit 1-3 years after H. pylori eradication in ulcer patients: impact of gastroesophageal reflux disease

OBJECTIVES: Eradication of Helicobacter pylori (H. pylori) infection markedly reduces the recurrence of duodenal and gastric ulcers. However, there is little information regarding its efficacy in resolving dyspeptic symptoms in ulcer patients. The primary aim of this study was to assess the effect of eradicating H. pylori infection on dyspeptic symptoms in ulcer patients. The secondary aim was to identify predictors of symptomatic response to H. pylori eradication. METHODS: A total of 97 dyspeptic patients with active duodenal and/or gastric ulceration associated with H. pylori infection and unrelated to NSAID use had the severity and character of their dyspeptic symptoms measured before and again 1-3 yr after H. pylori eradication therapy. RESULTS: Pretreatment, the median dyspepsia score was 12 (4-16). Posttreatment, 55% of those eradicated of H. pylori had resolution of dyspepsia (score <2) compared with 18% of those not eradicated of the infection (95% CI for difference, 11-62%). Of the ulcer patients 31% had symptoms and/or endoscopic evidence of coexisting gastroesophageal reflux disease (GERD) at initial presentation and this influenced the symptomatic response to eradication of H. pylori. Of the 22 patients with heartburn or acid reflux as the predominant presenting symptom, but no endoscopic esophagitis, only 27% experienced resolution of dyspepsia after H. pylori eradication, compared with 68% of the 59 without those as predominant symptoms (95% CI for difference, 18-63%). Only one of the five patients with coexisting endoscopic esophagitis at initial presentation experienced resolution of dyspepsia after H. pylori eradication. Symptomatic benefit was unrelated to time lapsed since the infection was eradicated. Only three of 50 subjects developed de novo GERD symptoms after eradication of H. pylori, whereas 21 of 36 subjects experienced resolution of GERD symptoms after eradication of the infection. CONCLUSIONS: A substantial proportion of ulcer patients have symptoms and/or signs of coexisting GERD at initial presentation and this reduces the symptomatic benefit from H. pylori eradication. However, we have found no evidence that eradicating H. pylori induces de novo GERD symptoms in ulcer patients.     

Prevalence of Helicobacter pylori infection, endoscopic gastric findings and dyspeptic symptoms among a young Japanese population born in the 1970s

BACKGROUND: With the prevalence of Helicobacter pylori (H. pylori) infection rapidly decreasing in Japan, endoscopic findings and dyspeptic symptoms need to be re-evaluated. METHODS: In a health check-up program, endoscopy was performed on 530 young Japanese subjects (371 men and 159 women) born in the 1970s. Helicobacter pylori infection was evaluated using serology and a rapid urease test. Endoscopic gastritis was classified according to the Sydney classification system, in addition to nodular gastritis. Dyspeptic symptoms were also recorded before endoscopy. RESULTS: Of the 530 subjects, 87 (16.4%) were H. pylori positive. Of the 443 H. pylori-negative subjects, 349 (78.8%) were considered to have endoscopically normal gastric mucosa. However, of the 87 H. pylori-positive subjects, only 19 (21.8%) tested normal (P < 0.001). The prevalence of several types of gastritis was significantly higher in H. pylori-positive subjects compared with H. pylori-negative subjects: atrophic gastritis (37.9% vs 1.1%, P < 0.001), flat erosive gastritis (29.9% vs 7.2%, P < 0.001), rugal hyperplastic gastritis (12.6% vs 0.0%, P < 0.001), and nodular gastritis (13.8% vs 0.0%, P < 0.001). Other types of gastritis were not related to H. pylori status. The prevalence of subjects with dyspeptic symptoms was significantly higher in H. pylori-positive subjects compared with H. pylori-negative ones (28.7% vs 6.5%, P < 0.001). CONCLUSION: It is suggested that in consideration of its recent low prevalence and the slow increase in its infection, the prevalence of H. pylori-related gastritis will gradually decrease in Japan. Further studies will be required to ascertain if there is a need for H. pylori eradication in this young population.     

Comparison of clinical, serological and histological findings between non-ulcer dyspepsia patients with and without Helicobacter pylori infection

BACKGROUND AND AIMS: The role of Helicobacter pylori (H. pylori) infection in non-ulcer dyspepsia (NUD) remains controversial. This study investigates the clinical, serological and histological differences between patients with H. pylori-positive and -negative NUD. METHODS: One hundred and eighty consecutive patients with NUD were enrolled from January to December 1998. The severity of symptoms was evaluated by the Tucci's scoring system. The histological changes of gastric mucosa were assessed according to the Updated Sydney System, and a fasting blood sample was obtained to test the serum gastrin and pepsinogen I levels. RESULTS: The H. pylori-positive NUD patients were notably older than H. pylori-negative NUD patients (48.2 +/- 15.9 vs 39.8 +/- 15.7 years, P= 0.001). There were no differences in other clinical factors between the two NUD groups. The serum pepsinogen I levels were considerably higher in H. pylori-positive NUD patients than in H. pylori-negative NUD patients (78.9 +/- 42.2 vs 61.5 +/- 43.3 ng/mL, P<0.01). However, no significant differences in serum gastrin levels were discovered between the two groups. The antrum histological scores for chronic inflammation, acute inflammation, gland atrophy and lymphoid follicles were higher in H. pylori-positive NUD patients than in H. pylori-negative NUD patients (2.09 vs 1.01, P<0.001; 1.22 vs 0.36, P<0.001; 0.76 vs 0.36, P<0.01; 0.33 vs 0.13, P<0.01, respectively). CONCLUSIONS: The present study discovered marked differences in age, serum pepsinogen I levels, histological grades of acute inflammation, chronic inflammation, gland atrophy and lymphoid tissue formation between H. pylori-positive and H. pylori-negative NUD patients. Further investigation of the clinical prognosis of the two groups of patients is necessary.     

Halitosis in patients with Helicobacter pylori-positive non-ulcer dyspepsia: an indication for eradication therapy?

BACKGROUND: The aims of this study were to investigate the frequency of halitosis before and after eradication therapy and to determine whether halitosis is a valid indication for eradication therapy in patients with Helicobacter pylori (H. pylori)-positive non-ulcer dyspepsia. METHODS: Dyspepsia, related symptoms, and halitosis were investigated by way of a questionnaire. Only H. pylori-positive patients who showed no organic lesions on endoscopic examination and no atrophy histopathologically were included. A total of 148 patients fulfilled the above criteria and completed the study. Four weeks after the end of eradication treatment, the symptoms were re-evaluated and repeat endoscopy was done to check for H. pylori in the gastric mucosa. Results: H. pylori eradication was successful in 109 patients (73.6%). Prior to treatment, bloating was the most frequent symptom (74.3%), followed by diurnal pain (62.2%) and halitosis (61.5%). The most successfully resolved symptoms in the group as a whole, regardless of eradication status, were halitosis, diurnal pain, and hunger-like pain, respectively. In the patients with confirmed H. pylori eradication, the most successfully resolved symptoms were halitosis and hunger-like pain, respectively. CONCLUSION: Halitosis is a frequent, but treatable, symptom of H. pylori-positive non-ulcer dyspepsia and may be a valid indication for eradication therapy.     

H pylori： Treatment for the patient only or the whole family？

AIM： To compare the effects of treatment of H pyloriinfected individuals with the effects of treatment of individuals as well as all Hpylori-infected family members.
METHODS： H pylori-positive patients with similar demographic specifications were prospectively randomized with respect to treatment, with a triple regimen of either patients and all Hpylori-positive family members living together （group Ⅰ ） or patients only （group Ⅱ）. Nine months after treatment, all patients were assessed for H pylori positivity.
RESULTS： There were 70 H pylori-positive patients in each group; patients in groups Ⅰ and Ⅱ lived with 175 and 190 Hpylori-positive relatives, respectively. Age, sex and Hpylori positivity rate were similar in both groups of relatives. Nine months after 14 d standard triple therapy, Hpylori positivity was 7.1% in group I patients and 38.6% in group 11 patients [P 〈 0.01, OR = 8.61 95% confidence interval （CI）： 2.91-22.84].
CONCLUSION： The present results indicate bad environmental hygienic conditions and close intra-familial relationships are important in H pylori contamination. These findings indicate all family members of H pyloripositive individuals should be assessed for H pylori positivity, particularly in developing countries where H pylori prevalence is high; they also suggest patients, their spouses and all H pyloN-positive family members of H pylori-positive individuals should be treated for H pylori infection.     

Delta (13)C-urea breath test value is a useful indicator for Helicobacter pylori eradication in patients with functional dyspepsia

BACKGROUND: Eradication of Helicobacter pylori is not routinely recommended for the symptomatic relief and the prevention of gastric cancer in patients with functional dyspepsia. The present study investigated a useful indicator of H. pylori eradication in such patients by determining the optimal cutoff value of a 13C-urea breath test (UBT). METHODS: One hundred dyspeptic patients participated in the study. Dyspepsia was scored, and a 13C-UBT administered. A level of delta 13C-UBT of>4 per thousand was diagnosed as H. pylori-positive. After the stomach was endoscopically sprayed with phenol red, biopsy specimens were taken from the antrum, body and cardia of the stomach for the assessment of H. pylori density, and activity (neutrophil infiltration) and degree (lymphocyte infiltration) of gastritis. RESULTS: Correlation between delta 13C-UBT and dyspepsia score was not found. Delta 13C-UBT significantly correlated with H. pylori density score in the total stomach (r = 0.53, P < 0.0001), neutrophil (r = 0.34, P = 0.0005) and lymphocyte score (r = 0.69, P < 0.0001). Twenty-six of the 100 subjects had a neutrophil score of >or=4, lymphocyte score of >or=4, and H. pylori score of >or=4. Their 95% confidence interval of mean was 58.2 per thousand, which reflects moderate to marked acute and chronic gastritis, and dense H. pylori colonization. CONCLUSIONS: The 13C-UBT is a reliable semiquantitative test to assess H. pylori density and the activity and degree of gastritis. It is proposed that H. pylori eradication therapy might be beneficial for patients with functional dyspepsia with a delta 13C-UBT of >58.2 per thousand.     

Endoscopic reflux esophagitis in patients with upper abdominal pain-predominant dyspepsia

BACKGROUND: Reflux symptom assessment had reliable accuracy in the diagnosis of gastroesophageal reflux disease (GERD). However, patients may recognize heartburn or regurgitation as dyspepsia because of inaccurate understanding or atypical presentation. The aim of the present study was to estimate endoscopic reflux esophagitis in patients with upper abdominal pain as a predominant symptom in the absence of heartburn or regurgitation. METHODS: Two hundred and sixty-three consecutive patients presenting dyspepsia without heartburn or regurgitation were enrolled. Patients with heartburn or regurgitation were excluded using the symptom interviewer method. Dyspepsia was categorized into pain-predominant or dysmotility-predominant groups according to the Rome II proposal. Endoscopic reflux esophagitis was graded using the Los Angeles classification. RESULTS: One hundred and five patients were included in the pain-predominant group and 119 in the dysmotility-predominant group. Reflux esophagitis was found in 18.8% (42/224) of all dyspeptic patients. Grade A esophagitis was noted in 27.6% (29/105) of the pain-predominant group and in 7.6% (9/119) of the dysmotility-predominant group. Grade B was noted in two patients in each group. A total of 29.5% (31/105) and 9.3% (11/119) had reflux esophagitis, respectively (P < 0.001). Comparing patients with or without reflux esophagitis, there was no difference in body mass index, smoking habit, alcohol consumption, or Helicobacter pylori infection status. CONCLUSIONS: A significant proportion of patients presenting dyspepsia, especially pain-predominant dyspepsia, have endoscopic reflux esophagitis. In view of GERD, pain-predominant dyspepsia should be investigated and managed differently from dysmotility-predominant dyspepsia.     

Helicobacter pylori and different topographic types of gastritis: treatment response after successful eradication therapy in functional dyspepsia

BACKGROUND: Helicobacter pylori gastritis is usually a lifelong disease which can cause different topographical inflammatory reactions and induce divergent effects on acid secretion in humans. High acid output and antrum-predominant gastritis are associated with duodenal ulcer disease, whereas corpus-predominat gastritis has been associated with low acid output and risk of gastric carcinoma. The objective of this study was to evaluate the role of different gastritis subtypes in the long-term treatment response of H. pylori-positive functional dyspepsia. METHODS: The gastric biopsies from 143 H. pylori-positive patients with functional dyspepsia were classified in accordance with the Sydney System as antrum-predominant gastritis, pangastritis or corpus-predominant gastritis. The patients were randomized to receive either eradication therapy or placebo antibiotics. Moreover, to standardize acid suppression every patient received omeprazole therapy for the first 3 months. Dyspeptic symptoms were evaluated from a questionnaire and the follow-up time was 12 months. In addition, delta-over-baseline (DOB) values of the 13C-urea breath test (UBT) were analysed from a subgroup of 36 patients to measure urease activity of the stomach. RESULTS: After 1 year, the dyspepsia symptom score was 7.4 +/- 3.0 (95% CI 6.6-8.2) in successfully H. pylori-eradicated patients and 7.6 +/- 3.1 (95% CI 6.9-8.4) in controls (P = ns). Among patients with antrum-predominant gastritis, dyspepsia score was reduced more in subjects whose H. pylori was eradicated than in controls with ongoing infection (-3.6 +/- 2.9 versus -1.7 +/- 2.9; P = 0.05). High urease activity of the stomach was associated with severe or moderate chronic antrum-predominant gastritis. CONCLUSIONS: Patients with antrum-predominant H. pylori-positive chronic gastritis and functional dyspepsia get symptom improvement after successful eradication therapy. A high DOB value of UBT is associated with these patients.     

Gastric electrical activity and gastrointestinal hormones in dyspeptic patients

AIMS: To explore the patterns of gastric electrical activity, gastric emptying and gastrointestinal hormones in dyspeptic patients and relate them to Helicobacter pylori status. METHODS: Twenty-two patients with functional dyspepsia and 29 healthy volunteers underwent cutaneous electrogastrography and dynamic ultrasound before and after a test meal. All dyspeptic patients underwent endoscopy and biopsy; all subjects were examined for the presence of antibodies to H. pylori, and the plasma levels of gastrin, neurotensin, cholecystokinin, and pancreatic polypeptide were measured. RESULTS: The area under the curve (AUC) of the normal slow wave percentage was lower in dyspeptic patients than controls (Kruskal-Wallis p = 0.016; Dunn's test: H. pylori-positive patients: 21,235.5 [19,101.0-22,688.8] vs. H. pylori-negative controls: 22,532.0 [20,133.0-23,755.0], p < 0.05). The AUC of the tachygastria percentage was higher in dyspeptic patients than controls (p = 0.0001; H. pylori-positive patients: 2,173.5 [325.8-3,055.3] vs. H. pylori-negative controls: 682.0 [118.5-1,902.4], p < 0.05; H. pylori-negative patients: 1,843.0 [1,107.0-4,277.0] vs. H. pylori-negative controls: 682.0 [118.5-1,902.4], p < 0.05). The AUC of gastrin was higher in H. pylori-positive than H. pylori-negative subjects (p = 0.0002; H. pylori-positive patients: 16,146.5 [11,368.8-33,141.7] vs. H. pylori-negative controls: 11,250.0 [5,674.0-17,448.0], p < 0.05; H. pylori-positive controls: 20,250.0 [12,070.0-64,430.0] vs. H. pylori-negative controls: 11,250.0 [5,674.0-17,448.0], p < 0.05). In the total group of dyspeptic patients and in the H. pylori-positive patients, a negative correlation was found between the AUC of neurotensin and the total score for postprandial fullness (dyspeptic patients r = -0.51, p = 0.01; H. pylori-positive patients r = -0.66, p = 0.02). CONCLUSIONS: In dyspeptic patients, alterations in gastric electrical activity were not related to H. pylori infection. Nevertheless, H. pylori infection induces higher gastrin levels in both patients and asymptomatic subjects.     

Helicobacter pylori and gastrointestinal symptoms in school children in Russia

BACKGROUND AND AIMS: Helicobacter pylori is considered to be the major cause of chronic gastritis and duodenal ulcer disease recurrence in childhood. However, the association between H. pylori and recurrent abdominal pain (RAP) syndrome is still controversial. Therefore, the spectrum of clinical variants of gastrointestinal symptoms associated with H. pylori-positive status was studied in consecutive symptomatic children who were undergoing diagnostic endoscopy. METHODS: A consecutive series of 225 school children from the Ural area of Russia (mean age 11.1 + 1.4 years, age range 7-15 years) who presented with RAP were investigated using esophagogastroduodenoscopy, including three antral biopsies for histology and polymerase chain reaction. Helicobacter pylori immunoglobulin G antibodies were found using a second-generation enzyme immunoassay. Information about the clinical symptoms was collected using a special questionnaire. RESULTS: The authors found a high incidence of H. pylori infection (80%) and peptic ulcers (16%) in 225 school children from the Ural area of Russia who were referred for upper gastrointestinal (UGI) endoscopy for chronic abdominal pain. Of the overall 225 symptomatic children who underwent endoscopy, 182 (80,8%) were found to be H. pylori-positive. Duodenal ulcers were detected in 36 H. pylori-positive children. A family history of peptic ulcers was significantly more frequent in the children infected with H. pylori (P < 0.001). Symptom score and duration of symptoms were similar, but night-time pain (P < 0.0001) and fasting pain relieved by food (P < 0.001) were more frequent in the H. pylori-positive children as compared with the H. pylori-negative children. CONCLUSIONS: The present results provide further evidence for a significant association between H. pylori and some patterns of gastrointestinal symptoms in children who underwent UGI endoscopy in order to exclude an organic cause of severe chronic gastrointestinal disorders.     

Role of anti-Helicobacter pylori treatment in H. pylori-positive and cytoprotective drugs in H. pylori-negative, non-ulcer dyspepsia: Results of a randomized, double-blind, controlled trial in Asian Indians

BACKGROUND: The efficacy of anti-Helicobacter pylori treatment and cytoprotective drugs in H. pylori-positive and -negative non-ulcer dyspepsia (NUD), respectively, is debatable. METHODS: In a randomized study, the efficacy of anti-H. pylori treatment versus sucralphate was tested in patients with NUD. One hundred and twelve patients with NUD, 62 positive and 50 negative for H. pylori were studied. Of 62 patients positive for H. pylori, 32 were treated with triple therapy (colloidal bismuth subcitrate, tetracycline and metronidazole) for 2 weeks and the remaining 30 were treated with sucralphate (1 g, q.i.d.) for 4 weeks. Of 50 patients negative for H. pylori, 25 each were treated with either sucralphate (1 g, q.i.d.) or ranitidine (150 mg, b.d.) for 4 weeks. RESULTS: In patients with NUD and H. pylori infection, triple therapy eradicated H. pylori in 88% and was superior to sucralphate in producing symptom relief (81 vs 33%, P = 0.0003) and histological improvement in gastritis (73 vs 30%, P = 0.003). In the H. pylori-negative group, sucralphate was superior to ranitidine with regard to symptom relief (68 vs 36%, P = 0.04) and improvement in gastritis (44 vs 12%, P = 0.09). The symptomatic improvement persisted until 12 weeks after the start of treatment in triple therapy group only. CONCLUSIONS: In patients with NUD associated with H. pylori, triple therapy was better than sucralphate in terms of symptomatic and histological improvement. However, sucralphate was superior to ranitidine in providing symptom relief in patients with H. pylori-negative NUD.     

Lack of benefit of treating Helicobacter pylori infection in patients with functional dyspepsia. Randomized one-year follow-up study

BACKGROUND/AIMS: To assess whether H. pylori therapy is significantly better than control therapy in patients with functional dyspepsia, and to assess whether curing the infection relieves symptoms of dyspepsia. METHODOLOGY: We prospectively included consecutive H. pylori-positive patients in whom a gastroscopy was carried out and who were diagnosed of functional dyspepsia. At endoscopy, biopsies were obtained (histology and rapid urease test), and a 13C-urea breath test was carried out. Patients were randomly assigned to 10 days of treatment with either eradication therapy (omeprazole, amoxicillin and clarithromycin) or with ranitidine. No antisecretory therapy was prescribed thereafter. Breath test was repeated four weeks after completing eradication treatment. A validated five-point Likert scale was used to measure severity of symptoms, both at the beginning of the study and 6 and 12 months after treatment. RESULTS: Fifty patients were included in the study. Sixteen patients were randomized to ranitidine and 34 to eradication treatment. The two groups were well balanced for base-line characteristics. One patient in each treatment arm was lost to follow-up at 12 months. Differences between ranitidine and eradication groups were not demonstrated in any of the symptom comparisons, either initially or at 12 months. The rates of treatment success for each symptom were similar in both groups. H. pylori was eradicated in 76% of the patients receiving antibiotics. Differences between groups of patients with eradication success and failure were not demonstrated in any of the symptom comparisons, either initially or at 12 months. Among the groups given eradication regimen, the rates of treatment success for each symptom were similar in the group with H. pylori eradication success and failure. CONCLUSIONS: H. pylori eradication is not likely to play a major role in the treatment of symptoms in patients with functional dyspepsia.