Effect of pantoprazole and Helicobacter pylori therapy on uninvestigated dyspeptic patients

Abstract

Background/Aims: This study aimed to test the efficacy of empirical proton pump inhibitor use and Helicobacter pylori therapy for uninvestigated dyspepsia in a population with a high prevalence of H. pylori. Material and Methods: The study had a two-stage design. In the first stage, the efficacy of 4-week pantoprazole treatment was compared with placebo in patients with uninvestigated dyspepsia. In the second stage, the efficacies of 2-week treatment with pantoprazole in H. pylori-negative patients and H. pylori eradication therapy (pantoprazole + amoxicillin + clarithromycin) in H. pylori-positive patients were compared. The primary endpoint was sufficient overall symptom relief (Global Overall Symptom score ≤2; no or minimal symptoms) at the end of treatment. Results: In the first stage, sufficient overall symptom relief was achieved by 25.2% of patients in the pantoprazole group and 15.5% of patients in the placebo group, a difference that was not statistically significant (p=0.06). In the second stage, the rate of sufficient overall symptom relief was higher in the H. pylori therapy group than in the pantoprazole group (37.1% vs. 23.4%; p=0.02). After untreated follow-up, sufficient overall symptom relief remained significantly higher in the H. pylori therapy group than in the pantoprazole group (39.7% vs. 18%; p<0.001). Almost all patients receiving pantoprazole experienced symptom relapse after treatment. Conclusions: This study validated the use of a test-and-treat strategy against H. pylori in uninvestigated dyspepsia, which may be an advisable treatment approach for uninvestigated dyspeptic patients in countries with a high prevalence of H. pylori.

Functional gastrointestinal disorders. Overlap syndrome Clinical guidelines of the Russian Scientific Medical Society of Internal Medicine and Gastroenterological Scientific Society of Russia

“…Было проведено шесть РКИ, в которых оценивали результаты лечения 2709 пациентов с диспепсией (ИПП с плацебо или ИПП с антацидами). В большинстве исследований сообщалось о статистически значимом влиянии терапии ИПП: симптомы диспепсии присутствовали у 50% в группе ИПП по сравнению с 73% в группе плацебо с NNT =6 (95% ДИ = 4-11) [120,121,122,123,124,125]. Имеются данные о преимущественной эффективности ИПП при СЭБ, а также при сочетании ФД и ГЭРБ [126,127].…”