Assessment of symptomatic response as predictor of Helicobacter pylori status following eradication therapy in patients with ulcer.
BACKGROUND
Helicobacter pylori eradication therapy is routinely used for treating patients with peptic ulcer disease.


OBJECTIVE
To assess the value of symptomatic response to H pylori eradication therapy as a marker of post-treatment H pylori status.


METHODS
One hundred and nine dyspeptic patients with active duodenal or gastric ulceration association with H pylori infection had their symptoms measured by a validated questionnaire before and three months following H pylori eradication therapy. The symptomatic response was compared with post-treatment H pylori status as determined by the 14C urea breath test.


RESULTS
An eradication rate of 84% was achieved. Of the 92 patients eradicated of H pylori, 47% experienced complete or near complete resolution of dyspepsia. Of the 17 patients in whom the infection was not eradicated, only one (6%) experienced resolution of dyspepsia. Resolution of dyspepsia was therefore a powerful predictor of eradication of H pylori with a predictive value of 98%. In contrast, persistence of dyspepsia was a weak predictor of persisting infection with a predictive value of only 25%. Excluding patients with endoscopic evidence of coexisting oesophagitis and/or retrosternal discomfort or reflux at initial presentation did not increase the predictive value of persisting dyspepsia for persisting infection.


CONCLUSIONS
Complete resolution of dyspeptic symptoms is a powerful predictor of eradication of H pylori infection in ulcer patients. Persistence of symptoms is a weak predictor of persisting infection and patients with persisting dyspepsia must have their H pylori status rechecked to guide future management.
McColl
K E
KE
University Department of Medicine and Therapeutics, Western Infirmary, Glasgow, UK.
el-Nujumi
A
A
Murray
L S
LS
el-Omar
E M
EM
Dickson
A
A
Kelman
A W
AW
Hilditch
T E
TE
D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D000994:Antitrichomonal Agents / Q000627:therapeutic use; D001944:Breath Tests; D004359:Drug Therapy, Combination; D004415:Dyspepsia / Q000382:microbiology*; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D009942:Organometallic Compounds / Q000627:therapeutic use; D010406:Penicillins / Q000627:therapeutic use; D010437:Peptic Ulcer / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D011237:Predictive Value of Tests; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D000994:Antitrichomonal Agents; D009942:Organometallic Compounds; D010406:Penicillins; D008795:Metronidazole; D000658:Amoxicillin; C002791:bismuth tripotassium dicitrate; D009853:Omeprazole