Whether or not eradication of Helicobacter pylori improves the symptoms of non-ulcer dyspepsia is much debated. Two further papers discussing the issue have been published recently.
Dr R. Liisa Jaakkimainen (University of Toronto, Canada) and colleagues have reported a meta-analysis which shows an improvement in dyspeptic symptoms among patients with non-ulcer dyspepsia in whom H pylori was eradicated. The meta-analysis of five trials found that eradication resulted in a 1.9 fold improvement in dyspeptic symptoms (British Medical Journal 1999;319:1040). The authors say that it is not known if the magnitude of these estimates is large enough to influence clinical guidelines but that it could provide information for sample size calculations for future studies.
However, in the New England Journal of Medicine (1999;341: 1106), Dr Nicholas Talley (University of Sydney, Australia) and colleagues report the results of a randomised clinical trial in which they found no evidence that eradicating H pylori infection in such cases leads to relief of symptoms. In their trial, conducted in patients with non-ulcer dyspepsia and confirmed H pylori infection, 150 patients received eradication therapy of omeprazole, amoxycillin and clarithromycin for two weeks and 143 received placebo medication. At four to six weeks post therapy, 90 per cent of the treatment group and 2 per cent of the placebo group were H pylori negative. At 12 months, 80 per cent of the treatment group and 5 per cent of the placebo group were H pylori negative.
Treatment was considered successful if the patient had no, or only mild, pain or discomfort. In 46 per cent of the treatment group and 50 per cent of the placebo group, treatment was successful at 12 months. There was no significant difference in mean symptom score between the two groups.