Is Helicobacter pylori the cause of dyspepsia?

Abstract

Objective-To determine the association between infection with Helicobacterpylori and dyspepsia.Design-Cross sectional study of dyspeptic subjects and age and sex matched controls identified by a questionnaire survey of ali inhabitants aged 20-69. (Endoscopy, histological examination, and microbiological examinations of biopsies from the gastric mucosa were performed blind.)Setting-Population based survey in S0rreisa, Norway.Subjects-All 782 dyspeptic subjects (excluding those with a previous history of peptic ulcer, gall stones or kidney stones, and coronary heart disease) and controls were offered an endoscopy, of whom 309 dyspeptic subjects and 310 controls attended.Main outcome measures-Prevalences of endoscopic and histological diagnoses and of cultures positive for H pylori.Results-A high prevalence of positive cultures, increasing with age, was found in both dyspeptic subjects (48%) and non-dyspeptic controls (36%) (p=0O004). Positive cultures in both dyspeptic subjects and controls were strongly associated with histological gastritis (70%, 95% confidence interval 65*5 to 85-3; 60%, 52-7 to 67.7, respectively) and peptic ulcer (92%, 61*5 to 99-8; 64-1, 9-4 to 99-2, respectively). Only 3% of subjects with a histologically non-inflamed gastric mucosa had this infection (dyspeptic subjects 2%, 0-2 to 7-0; controls 4%; 1-2 to 8-8).Conclusions-The relation between dyspeptic symptoms and H pylon is dubious; H pylori seems to have a pathogenetic role in gastritis and may be a contributing factor but not a cause of peptic ulcer.

Clinical practice - strategies for management of dyspepsia

“…Bernersen et al found similar results and, in this study, a random population sample was endoscoped whether or not they had symptoms 29 .…”

Factors associated with gastro-duodenal disease in patients undergoing upper GI endoscopy at the Korle-Bu Teaching Hospital, Accra, Ghana

“…Non-ulcer dyspepsia had a significantly lower prevalence of H. pylori infection (53.1%) when compared with ulcer dyspepsia (83-88%). This would be supported by studies showing no correlation with infection in such patients 4,[15][16][17] . Eradication of H. pylori was however associated with a small but significant benefit, with treatment of 14 patients needed to cure one case of NUD 18 .…”

Aspectos epidemiológicos do Helicobacter pylori na infância e adolescência

“…Acredita-se que mais de um terço dos carcinomas gástri-cos seja atribuído à infecção pelo H. pylori. 26,33,73,100 Outras afecções associadas à infecção pelo H. pylori são linfoma de tecido linfóide associado à mucosa gástrica -MALToma, 105 dispepsia não-ulcerativa, 10,12 doenças coronarianas e cardiovasculares, 90,108,98,107 urticária idiopática crônica, 29,110,129 doenças auto-imunes (púrpura de Henoch-Shönlein, 77,111 trombocitopenia auto-imune, 43 síndrome de Sjögren 37 ) e enxaqueca. 42 Estudos sugerem que existe aumento na incidên-cia de refluxo gastroesofágico (RGE) após erradicação do H. pylori da mucosa gástrica.…”