Patients with dyspepsia benefit from eradication of helicobacter pylori if other organic causes for dyspepsia were carefully ruled out

Aim: in order to investigate the potential of Helicobacter pylori (NP) to induce dyspepsia. we performed a randomized prospective study on the long-term effect of HP-eradication on symptoms of HP-positive dyspeptic patients in whom other organic causes for dyspepsia were carefully ruled out. Patients: 201 patients referred to our endoscopy unit with dyspeptic symptoms for at least six months entered the study. Patients with precious peptic ulcer were excluded. Methods: After endoscopy of the upper alimentary tract and (13)-Curea breath test, patients with active peptic ulcer. hiatal hernia. macroscopic evidence for esophagitis and negative HP-status sere excluded. The remaining patients underwent abdominal sonographgy, H-2-exhalation test with lactose, and 24-h monitoring toring in order to exclude other organic causes for dyspepsia. In 20 patients, dypepsi was assumed to be due to HP-gastritis. Patients received eradication therapy and were controlled as as sessed by the C-13-urea breath test six weeks and six months after completion of the therapy Dyspeptic symptoms were monitored by means of a validated symptom score. Results: but of 20 patients with KP-gastritis the fist eradication treatment was successful in 13, while seven patients remained HP-positive after antibiotic treatment. Six months after completion of therapy the symptoms of HP-eradicated patients improved considerably (score values 17.4 +/- 1.5 and 10.2 +/- 0.8, respectively, p < 0.01) whereas symptoms of patients with persistent infection remained unchanged (21.1 +/- 1.7 and 20.4 +/- 1.5, n.s.) and only improved after successful retherapy (20.4 +/- 1.5 and 11.7 +/- 2.1. p < 0.05). In total, 17 of 20 patients (85%) improved after successful eradication Also, neutrophil infiltration in the gastric mucosa correlated to both dyspeptic symptoms before therapy (r = 0.85) and the decrease in symptom score after HP-eradication (r = 0.61). In contrast, the symptoms of eight patients with gastroesophageal reflux disease were not improved after eradication (20.0 +/- 1.1 and 18.2 +/- 1.0, n. s.) Conclusions: HP-infection per se contributes to dyspepsia. 17 of 20 (85%) HP-positive dyspeptic patients improved after HP-eradication, when other potential organic causes for dyspepsia had been ruled out. However, many patients did not completely recover but the symptoms only partly decreased which parallels the persistence of part of the inflammatory infiltration in the gastric mucosa. This emphasizes the importance of WP-gastritis as an organic disease causing dyspeptic symptoms.