H. pylori eradication associated with improvement and cure of FD symptoms: Study

Functional dyspepsia (FD) is a chronic disorder that is difficult to treat. Helicobacter pylori may contribute to its pathophysiology. A Cochrane review from 2006 suggested that eradication therapy was beneficial, but there have been numerous randomised controlled trials (RCTs) published since. We evaluated the impact of eradication therapy on both cure and improvement of functional dyspepsia, as well as whether any benefit was likely to arise from the eradication of H. pylori.

They searched the medical literature through October 2021 to identify RCTs examining the efficacy of eradication therapy in H. pylori-positive adults with functional dyspepsia. The control arm received antisecretory therapy or prokinetics, with or without placebo antibiotics, or placebo alone. Follow-up was for ≥3 months. They pooled dichotomous data to obtain a relative risk (RR) of symptoms not being cured or symptoms not improving with a 95% CI. Researchers estimated the number needed to treat (NNT).

Results:

Twenty-nine RCTs recruited 6781 H. pylori-positive patients with functional dyspepsia. Eradication therapy was superior to control for symptom cure (RR of symptoms not being cured=0.91; 95% CI 0.88 to 0.94, NNT=14; 95% CI 11 to 21) and improvement (RR of symptoms not improving=0.84; 95% CI 0.78 to 0.91, NNT=9; 95% CI 7 to 17). There was no significant correlation between eradication rate and RR of functional dyspepsia improving or being cured (Pearson correlation coefficient=−0.23, p=0.907), but the effect was larger in patients with successful eradication of H. pylori than with unsuccessful eradication (RR=0.65; 95% CI 0.52 to 0.82, NNT=4.5, 95% CI 3 to 9). Adverse events (RR=2.19; 95% 1.10 to 4.37) and adverse events leading to withdrawal (RR=2.60; 95% CI 1.47 to 4.58) were more common with eradication therapy.

There is high-quality evidence to suggest that H. pylori eradication therapy leads to both cure and improvement in functional dyspepsia symptoms, although the benefit is modest.

Reference:

Efficacy of Helicobacter pylori eradication therapy for functional dyspepsia: updated systematic review and meta-analysis by Alexander C Ford et al. published in the Gut.

https://gut.bmj.com/content/early/2022/01/11/gutjnl-2021-326583

Keywords:

H. pylori, eradication, associated, improvement, cure, functional, dyspepsia, gut, bmj journal, Alexander C Ford, Evangelos Tsipotis, Yuhong Yuan, Grigorios I Leontiadis, Paul Moayyedi,