title: Assessment of symptomatic response as predictor of Helicobacter pylori status following eradication therapy in patients with ulcer.
abstract: 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.
authors.affiliation: University Department of Medicine and Therapeutics, Western Infirmary, Glasgow, UK.
authors.forename: K E
authors.initials: KE
authors.lastname: McColl
authors.forename: A
authors.initials: A
authors.lastname: el-Nujumi
authors.forename: L S
authors.initials: LS
authors.lastname: Murray
authors.forename: E M
authors.initials: EM
authors.lastname: el-Omar
authors.forename: A
authors.initials: A
authors.lastname: Dickson
authors.forename: A W
authors.initials: AW
authors.lastname: Kelman
authors.forename: T E
authors.initials: TE
authors.lastname: Hilditch
mesh_terms: 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
chemical_list: 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