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Helicobacter pylori infection in functional dyspepsia

Abstract

Functional dyspepsia is the most common reason for patients to experience chronic epigastric pain or discomfort. The causes of functional dyspepsia are multifactorial but Helicobacter pylori infection is one likely candidate. Infection with this bacterial pathogen clearly results in chronic mucosal inflammation in the stomach and duodenum, which, in turn, might lead to abnormalities in gastroduodenal motility and sensitivity. Chronic gastritis might also affect a variety of endocrine functions of the stomach including the production of the gastrointestinal hormones and neurotransmitters somatostatin, gastrin and ghrelin. Although these abnormalities might generate symptoms in some patients with functional dyspepsia, the clinical evidence needs to be critically evaluated before this hypothesis can be confirmed. A Cochrane review reported that eradication of H. pylori in these patients had a small but statistically significant long-term effect on symptom relief when compared with placebo, lasting at least 12 months after 1 week of eradication therapy. The efficacy of eradication therapy was seen in all symptom subtypes of functional dyspepsia, but was more marked in Asian than Western patients. This evidence has led to alterations in most of the major guidelines throughout the world, which now recommend H. pylori eradication in patients with functional dyspepsia if they test positive for this bacterium.

Key Points

  • Helicobacter pylori infection is a major cause of gastritis and is associated with a variety of motility, endocrine and acid-secretory abnormalities that could drive the symptoms of functional dyspepsia

  • In a meta-analysis of randomized controlled trials, H. pylori eradication had a small but statistically significant effect in controlling the symptoms of functional dyspepsia

  • H. pylori eradication improves symptoms in patients with epigastric-pain-predominant and postprandial-distress-predominant functional dyspepsia

  • The majority of guidelines recommend H. pylori eradication in at least a subset of patients with functional dyspepsia

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Figure 1: Symptoms of chronic gastritis caused by Helicobacter pylori infection.

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Acknowledgements

This work was supported by a Health and Labour Sciences Research Grant for Research on Health Technology Assessment (Clinical Research Promotion No. 47 to H. Suzuki) and a grant from the Smoking Research Foundation (to H. Suzuki), and the Keio Gijuku Academic Development Fund (to H. Suzuki).

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Correspondence to Hidekazu Suzuki.

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H. Suzuki has accepted research grants and honoraria from Astellas, AstraZeneca, Eisai, Otsuka, Daiichi–Sankyo, Dainippon–Sumitomo, Takeda, Tsumura and Zeria over the past 5 years. P. Moayyedi has accepted honoraria from AstraZeneca, Abbott, Pendopharm, Shire and Takeda over the past 5 years. His endowed Chair is partially funded by an unrestricted donation to McMaster University from AstraZeneca.

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Suzuki, H., Moayyedi, P. Helicobacter pylori infection in functional dyspepsia. Nat Rev Gastroenterol Hepatol 10, 168–174 (2013). https://doi.org/10.1038/nrgastro.2013.9

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