Should anti-Helicobacter therapy be different in patients with dyspepsia compared with patients with peptic ulcer diathesis?

Abstract

Physicians should try to reach an optimal cure rate with initial anti-Helicobacter therapy. Helicobacter pylori infection in patients with peptic ulcer disease (PUD) is more likely to be cured then in patients with 'functional' dyspepsia (FD). Differences in cure rates of 5-15% are usually reported, which is considered to be clinically relevant. Different strains (virulent v. non-virulent) in PUD and FD may induce different alterations in the gastric mucosa, and thereby either facilitate or impair antimicrobial efficacy. A study in this journal showed that triple therapy with ranitidine bismuth citrate (RBC) was superior to triple therapy with a proton pump inhibitor (PPI), but only in the more-difficult-to-cure FD patients. Clinicians should be aware that most published treatment studies have included only PUD patients. This means that in clinical practice the cure rates obtained in patients with FD or even uninvestigated dyspepsia will usually be lower then those reported in the literature. One way to deal with this is to consider prolonging the duration of an initial anti-Helicobacter therapy from 7 to 10 or 14 days in patients without ulcers.

Helicobacter pylori Eradication Therapy Success Regarding Different Treatment Period Based on Clarithromycin or Metronidazole Triple‐Therapy Regimens

“…Similarly, no difference in eradication success was observed between the 7 and 10 days protocols [8,11]. This has not been confirmed by all authors [9], probably due to the smaller number of patients studied or the high overall eradication success, as pointed out by de Boer et al [14]. Some of the published data indicate that eradication success depends on the proportion of patients with nonulcer dyspepsia included in the analysis [5,10].…”

2‐Week Triple Therapy for Helicobacter pylori Infection is Better Than 1‐Week in Clinical Practice: a Large Prospective Single‐Center Randomized Study

“…Some authors [37,38] have reported that the frequency of H. pylori eradication is higher in patients with PUD than in those with NUD, although this evidence has not been confirmed by other investigators, probably on account of the small number of patients studied or the high overall eradication rates, as pointed out by de Boer et al. [39]. However, in the present study conducted on a large number of patients and with a submaximal eradication rate, a comparable percentage of patients with PUD, NUD, or GERD were found to be cured of H. pylori infection.…”

Comparative study of Helicobacter pylori eradication rates of concomitant therapy vs modified quadruple therapy comprising proton‐pump inhibitor, bismuth, amoxicillin, and metronidazole in Korea

“…35 The difference of H. pylori strain in patients with peptic ulcer and functional dyspepsia may induce the biased result of eradication rate. First, there was the absence of antimicrobial susceptibility testing and culturing, because antibiotic resistance is the most important cause of treatment failure.…”