The prevalance of Helicobacter pylori in nonulcer dyspepsia and response to the eradication therapy

Year 2006, Volume: 5 Issue: 3, 173 - 178, 01.12.2006

Vedat Göral Mehmet Dönmez Hakan Temiz Dede Şit

Abstract

Background/aim: The etiology of nonulcer dyspepsia is unknown and many factors are suspected. H. pylori is one of the most often accused factors. Our aim was to research the frequency of H. pylori in nonulcer dyspepsia patients and to determine whether H. pylori is more frequent in nonulcer dyspepsia patients than in asymptomatic patients. We also evaluated the symptomatic improvement in H. pylori-positive patients. Materials and methods: 44 nonulcer dyspepsia patients (24 F, 20 M; mean age: 34.36 ± 13.08) were included in the study. 15 asymptomatic individuals (6 F, 9 M; mean age: 32.06 ± 15.09) were included as a control group. Results: H. pylori positivity was 56.8% according to urease test in nonulcer dyspepsia patients, and 20% in the control group. When we classified nonulcer dyspepsia patients to subgroups as ulcer-like, dysmotility-like and reflux-like, H. pylori positivity was 61.9%, 50% and 55.5%, respectively. Eradication therapy was applied to 27 H. pylori- positive patients in whom positivity was established by means of the urease test. Urea breath test was applied to 11 patients 6 weeks after the end of therapy. It was established that infection was eradicated in 5 patients (45.5%). Complaints were continuing in 6 patients in whom eradication was not achieved. Successful results were achieved in 2 of 11 (18.1%) patients by means of eradication therapy. Conclusion: The H. pylori prevalence is higher in patients with nonulcer dyspepsia than in healthy controls, but H. pylori eradication therapy is not useful.

Keywords

Non-ulcer dyspepsia, Helicobacter pylori

Nonülser dispepside Helikobakter pilori sıklığı ve eradikasyon tedavisine yanıt

Abstract

Giriş ve amaç: Nonülser dispepsi etyolojisi net olarak bilinmeyen ve birçok faktörün neden olarak öne sürüldüğü bir hastalıktır. H. pilori de suçlanan faktörlerden biridir. Amacımız nonülser dispepsi ile H. pilori arasındaki ilişikiyi ve eradikasyona yanıtı araştırmaktır. Gereç ve yöntem: Bu çalışmada, 24'ü kadın 20'si erkek olmak üzere 44 nonülser dispepsi hastası (yaş ort. 34,36 ± 13,08) yer almıştır. Kontrol grubu olarak 15 kişilik asemptomatik vaka ( 6 bayan, 9 erkek, yaş ortalaması 32,06 ± 15,09) alınmıştır. Bulgular: Nonülser dispepsi tanılı çalışma hastalarda üreaz testi ile H. pilori varlığı % 56,8 saptanmıştır. Kontrol grubunda ise %20 saptanmıştır. Nonülser dispepsili hastaları ülser benzeri, dismotilite benzeri ve reflü benzeri alt gruplara ayırdığımızda, üreaz testi ile H. pilori pozitifliği, sırasıyla % 61,9, %50,0 ve %55,5 olarak tespit edilmiştir. Üreaz testi ile H. pilori pozitifliği saptanan 27 kişiye eradikasyon tedavisi başlanmıştır. İlaçlarını düzenli kullanarak tedavi bitiminden 6 hafta sonra kontrole gelen 11 hastaya üre nefes testi uygulanmıştır. Üre nefes testi ile 5 hastada (%45, 45) infeksiyonun eradike edildiği gösterildi. Bu 5 hastadan 3'ünde, ilk başvurudaki şikayetler devam etmekteydi. Eradikasyonun sağlanamadığı 6 hastada ilk başvurudaki şikayetleri devam ettiği saptandı. Eradikasyon tedavisi 11 vakadan 2'sinde (%18,1) yüz güldürücü sonuca ulaşmıştır. Sonuç: Nonülser dispepside H. pilori sıklığı kontrol grubuna göre yüksek bulunmuştur, ancak H. pilori eradikasyonu yararlı bulunmamıştır.

Keywords

Nonülser dispepsi, Helikobakter pilori

References

• Dunn B E, Cohen H, Blaser M J. Helicobacter pylori. Clinical Mic- robiology Reviews 1997; 10: 720-41.
• Bazaldua V, Schneider D, Evaluation and Management of Dyspep- sia; American Family Physician 1999, 60: 1773-84.
• Talley NJ, Philip SF. Nonulcer dyspepsia: Potential causes and pat- hophysiology. Ann Intern Med 1988; 108: 865.
• Camilleri M, Malagelada JR, Kao PC; Zensmeister AR. Gastric and autonomic responses to stres and functional dyspepsia. Dig Dis Sci 1986, 31: 1169-77.
• Malagelada JR. Gastrointestinal motor disturbances and functional dyspepsia. Helicobacter pylori 1991; 26: 29.
• Testoni PA, Bagnolo F, Bologna P, et al. Higher prevalence of He- licobacter pylori infection in dyspeptic patients who do not have gastric phase III of the migrating motor complex: Scand J Gastro- enterol 1996; 31: 1063-8.
• Besheradus K, Leahy A, Mason I, et al. The effect of cisapride on dyspepsia symptoms and the electrogastrogram in patients with non-ulcer dyspepsia. Aliment Pharmacol Ther 1998; 12: 755.
• Stanghellini V, Tosetti C, Paternico A, et al. Risk indicators of dela- yed gastric emptying of solids in patients with functional dyspepsia. Gastroenterology 1996; 110: 1036-42.
• Sleisenger and Fordtran's Gastrointestinal and Liver Disease. Pat- hophysiology/Diagnosis/Management. Feldman M, W.B. Saunders, chapter: 7, 2002; 105-16.
• El-Omar E, Penman J, Ardill JE, Mc Coll KE. A substantial propor- tion of non-ulcer dyspepsia patients have the same abnormality of acid secretion as duodenal ulcer patients. Gut 1995; 36: 534-8.
• Collen MJ, Loebenherg MJ. Basal gastric acid secretion in nonul- cer dyspepsia with or without duadenitis. Dig Dis Sci 1989; 34: 246- 50.
• Mearin F, de Ribot X, Balboa A, et al. Does Helicobacter pylori in- fection increase gastric sensitivity in functional dyspepsia? Gut 1995; 37: 47.
• Talley NJ, Weaver Al, Zinsmester AR. Smoking, alcohol and non- steroidal anti-inflammatory drugs in outpatients with non-ulcer dyspepsia and among dyspepsia subgroups. Am J Gastroenterol 1994; 89: 524.
• Skoubo Kristensen E, Funch Jensen P, Kruse A et al. Controlled cli- nical trial with sucralfate in the treatment of macroscopic gastritis. Scand J Gastroenterol 1989; 24: 716-20.
• Greenberg RE, Bank S. The prevalence of Helicobacter pylori in no- nulcer dyspepsia. Arch Intern Med 1990; 150: 2053-5.
• Holtmann G, Goebell H. Holtmann M et al. H pylori and functional dyspepsia: increased serum antibodies an independent risk factor. Gastroenterology 1995; 108: 116.
• Soll AH. Medical treatment of peptic ulcer disease practice guideli- nes JAMA 1996; 275: 622-9.
• Buckley M, O’Marion CA. Prevalence of Helicobacter pylori in no- nulcer dyspepsia. Aliment Pharmacol Ther 1995; 9: 53.
• Hunt R, Thompson ABR. Canadian Helicobacter pylori consensus conference. Can J Gastroenterol 1998; 12: 31.
• Armstrong D. Helicobacter pylori infection and dyspepesia. Scand J Gastroenterol 1996; 31: 215: 38-47.
• Rauws EA, Langenberg W, Houthoff HJ et al. Campylobacter pylo- ridis-associated chorinc activi antral gastritis. A prospective study of its prevalence and the effects of antibacterial and antiulcer treat- ment. Gastroenterology 1988; 94: 33-40.
• Holtmann G, Goebell H, Holtmann M, et al. Dyspepesia in healthy blood donors. Pattern of symptoms and association with Helicobac- ter pylori. Dig Dis Sci 1994; 39: 1090-8.
• George AA, Tsuchiyose M, Dooley CP. Sensitivity of the gastric mu- cosa to acid and duodenal contents in patients with nonulcer dyspepsia. Gastroenterology 1991; 101: 3-6.
• Holtmann G, Talley NJ, Goebell H. Association between H. pylori, duodenal mechanosensory threshold and small intestinal motility in chronic unexplained dyspepsia. Dig Dis Sci 1996; 41: 1285-91.
• Qvist N, Rasmussens L, Axellson CK. Helicobacter pylori associated gastritis and dyspepsia: the influance on migrating motor comple- xes. Scand J Gastroenterology 1995; 90: 865-8.
• Murakami K, Fujioka F, Shiota K. Influence of Helicobacter pylori infection and the effects of eradication on gastric emptying in pati- ents with non-ulcer dyspepsia. Eur J Gastroenterol Hepatol 1995; 1: 593.
• R Liisa Jaakimainen, Boyle E, Tudiver F. Is Helicobacter associated with nonulcer dyspepsia and will eradication improve symptoms? A metaanalysis. BMJ 1999; 319: 1040-4.
• Laine L, Schoenfeld P, Fennerty B. Therapy for Helicobacter pylo- ri in patients with nonulcer dyspepsia: A meta-analysis of randomi- zed, controlled trials. Ann Intern Med 2001; 134: 361.
• Marshall BJ, Warren JR. Motility disorders and symptom improve- ment in nonulcer dyspepsia. Med J Aust 1997; 142: 436-9.
• Pereira-Lima JG, Scholl J, Pinheiro JB, et al. Helicobacter pylori- associated gastritis: does it play a role in functional dyspepsia? Z Gastroenterol 1995; 33: 421-5.
• Saruc M, Ozden N, Turkel N, et al. Functional dyspepsia: relations- hip between clinical subgroups and Helicobacter pylori status in Western Turkey. Braz J Med Biol Res. 2003; 36: 747-51.
• Tsega E, Gebre W, Manley P, et al. Helicobacter pylori, gastritis and non-ulcer dyspepsia in Ethiopian patients. Ethiop Med J 1996; 34: 65-71.
• Önder GF, Aydın A, Doğanavşargil B, et al. H. pylori infeksiyonun- da pantoprazol, amoksisilin, klaritromisin (PAK) kombinasyonu ile 1 ve 2 haftalık tedavilerin etkinliği. Turk J Gastroenterol 2003; 14 Supplement 1: 157.
• Yılmaz E, Bahri A. Helikobakter pilori (+) kronik aktif gastritli has- talarda değişik iki tedavi protokolünün etkinliği Akademik Gastro- enteroloji Dergisi 2002; 1: 82-5.
• Moayyedi P, Soo S, Deeks J, et al. Eradication of Helicobacter pylo- ri for non-ulcer dyspepsia. Cochrane Database Syst Rev 2001; 1: 2096.
• Ladron de Guevara L, Pena-Alfaro NG, Padilla L, et al. Evaluation of the symptomatology and quality of life in functional dyspepsia be- fore and after Helicobacter pylori eradication treatment. Rev Gast- roenterol Mex 2004 ; 69: 288-9.
• Gisbert JP, Calvet X, Gabriel R, et al. Helicobacter pylori infection and functional dyspepsia. Meta-analysis of efficacy of eradication therapy Med Clin (Barc) 2002; 118: 405-9.