Population screening and treatment for Helicobacter pylori will only have a small effect in reducing the rate of dyspepsia in the community. In addition, this effect is unlikely to have an important impact on quality of life in the general population, say Dr Paul Moayyedi (centre for digestive diseases, General infirmary at Leeds) and colleagues.
In a randomised controlled trial of 2,324 individuals who tested positive for H pylori, half were given active treatment for the eradication of H pylori and half were assigned placebo. After two years, 28 per cent of the treatment group and 33 per cent of the placebo group reported dyspepsia or symptoms of gastro-oesophogeal reflux. H pylori eradication had been achieved in 74 per cent of the treatment group and 5 per cent of the placebo group. The results indicated a 5 per cent absolute risk reduction of dyspepsia in the eradication group. The authors say that dyspepsia was associated with a poor quality of life that was not significantly improved by H pylori eradication.
While the trial did not investigate the underlying cause of dyspepsia, the authors comment that the reduction in dyspepsia observed in the study may be the result of eradication therapy curing symptomless peptic ulcers. They conclude that, overall, 20 people with H pylori infection would need to take eradication therapy for one case of dyspepsia to be successfully treated in the community.
This clinical effect was small, they say, and the cause of dyspepsia in the majority of cases was still uncertain. The clinical benefits of eradication therapy in the community rest on any effect it may have on mortality from gastric cancer, they add (Lancet 2000;355:1665).