GASTROENTEROLOGY LITERATURE ALERT!
LANDMARK ARTICLE - Required reading
| Talley NJ, Vakil N, Ballard ED, Fennerty MB. Absence of Benefit of Eradicating Helicobacter pylori in Patients With Nonulcer Dyspepsia. N Engl J Med 1999;341:1106-11. |
Major findings:
Patients studied had upper abdominal discomfort, for at least 3 months, at least twice a week and with a normal endoscopy study. Patients with symptoms typical of reflux or IBS were excluded.
170 patients received antibiotic therapy, 170 placebo. Rate of eradication was 90%.
Eradicating H. pylori in patients with non-ulcer dyspepsia was no more likely to result in resolution of symptoms than placebo. At 12 months, 46% in the active treatment group had resolved symptoms, compared to 50% in the placebo group.
No relationship between histologic improvement of gastritis and improvement in symptoms was noted
There was no difference in the rate of response even when dyspepsia patients were classified as ulcer-like, reflux-like or dysmotility-like and analyzed independently.
FACTS TO REMEMBER FOR BOARDS
Approximately 30% of patients with non-ulcer dyspepsia test positive for H. pylori.
Helicobacter pylori has been classified as a potential carcinogen by the World Health Organization
No association between improvement of histologic gastritis and symptoms has ever been shown before
Clinical application
At present, there is no indication to empirically eradicate H. pylori for the treatment of dyspepsia.
In patients with normal endoscopy, tests for H. pylori are not necessarily mandatory.
Once H. pylori is diagnosed, eradication has to be offered as the WHO classifies H. pylori as a carcinogen.