Helicobacter pylori eradication therapy in nonulcer dyspepsia is beneficial

Abstract

Non-ulcer dyspepsia (NUD) is a common condition, and no therapy is dramatically effective in treating this disorder. It is therefore vital that there should be a reliable evidence for the efficacy of treatments prescribed to NUD patients. This updated systematic review suggests that H. pylori eradication has a small but statistically significant benefit in treating NUD. One-half of the world's population has Helicobacter pylori (H. pylori) infection, with an estimated prevalence of 30% in North America[1–2] compared with a prevalence of 80–90% in the developing world.[3] The annual incidence of new H. pylori infections in industrialized countries is approximately 0.5 per 100 persons of the susceptible population compared with three or more per 100 persons in the developing countries.[4,5] In southern part of Saudi Arabia, H. pylori was present in 81% of nonulcer dyspepsia (NUD) patients (with normal esophago-gastroduodenoscopy [EGD]) reported[6] in 1993, but a recent report[7] after 11 years (2004) from the same area, showed a significant reduction (53%) in the incidence of H. Pylori. This reduction is most likely secondary to improved socioeconomic and hygienic conditions, in addition to widespread treatment of H. Pylori in dyspepsia patients. Risk factors for acquiring H. pylori infection include residence in a developing country, poor socioeconomic conditions, family overcrowding, and possibly an ethnic or genetic predisposition. Dyspeptic symptoms affect 15–40% of the adult population in the western world.[8] Most affected individuals do not have structural or biochemical alterations that could explain these symptoms and, thus, are classified as having nonulcer or functional dyspepsia.[9] The pathophysiology of NUD is poorly understood; it may be associated with changes in motility, secretion, or sensitivity of the digestive tract.[10–12] Data from epidemiological studies are controversial in terms of the association of H. pylori with NUD symptoms.[13–15] Clinical studies focusing on the symptomatic benefits of eradicating H. pylori infections in patients with NUD have yielded conflicting results.[16,17] The majority of these studies were performed in low-prevalence H. pylori infection populations. [18–22] There are few studies reporting the consequences of eradicating these bacteria in infected functional dyspeptic patients in high-prevalence populations. Brazil is a country with a high H. pylori prevalence, with 60–87% of the adult population being infected with the bacteria.[23–25] H. pylori infection is the main cause of peptic ulcer and eradication therapy successfully cures this chronic relapsing and remitting disease.[26] This discovery has made an enormous difference to patients with peptic ulcer disease, but this accounts for only 5–10% of the population that has dyspepsia.[27] The majority of patients with dyspepsia have a normal endoscopy and in the absence of predominant reflux symptoms these patients are defined as having NUD.[28] The pathogenesis of this condition is uncertain and is likely to be multifactorial. H. pylori infection may have a role in this disorder, as the organism causes a chronic inflammatory response and has effects on gastric acid secretion.[29] The effect of H. pylori eradication therapy on NUD symptoms has been evaluated in several large, well designed, randomized controlled trials (RCTs).[30] Systematic reviews of RCTs can be a powerful method of assessing the effectiveness of a therapy. Unfortunately, many high-quality systematic reviews have been published with differing conclusions. This review aims to show that H. pylori eradication is beneficial and cost-effective in the treatment of NUD.