Efficacy of Helicobacter pylori eradication in uninvestigated chronic dyspeptic staff members of a large factory: a prospective, long-term, follow-up, workplace outcome study.
BACKGROUND
Current European guidelines propose Helicobacter pylori eradication for the initial management of patients under 45 years with uninvestigated dyspepsia without alarm symptoms. Until now, no study has assessed this strategy in occupational medicine.


OBJECTIVE
To investigate the outcome of H. pylori eradication in staff members of a large factory with uninvestigated chronic dyspepsia in a prospective, open, controlled, workplace outcome study in terms of the 1 year follow-up of dyspepsia and quality of life.


METHODS
In 267 subjects with uninvestigated chronic dyspepsia (229 males, mean age 42 years; range 22-62 years) H. pylori status was assessed by using the 13C-urea breath test at baseline. H. pylori-positive subjects were offered 1 week eradication therapy with omeprazole 20 mg b.i.d., clarithromycin 250 mg b.i.d., and metronidazole 400 mg b.i.d., and were retested after 2 months. Subjects with a negative 13C-urea breath test at 2 months were H. pylori-responders; subjects still H. pylori-positive at this time were H. pylori-nonresponders. H. pylori-negative subjects at baseline were included as a reference. Dyspeptic symptoms, quality of life and health care utilization were assessed by questionnaires at baseline (T0), and at 2 (T2) and 12 months (T12).


RESULTS
One hundred and eleven of 267 (41.65%) subjects were H. pylori-positive at baseline. The infection was cured in 85 of 94 (90.4%) subjects. Upper abdominal pain and dyspeptic symptoms were significantly reduced and quality of life significantly increased in H. pylori responder subjects at T12 compared to baseline and to reference subjects (P < 0.01). At T12 42.3% of H. pylori responder subjects showed complete relief of epigastric pain compared to 9.2% in the reference group (P < 0.001). Furthermore, disease-related absence from work, visits to family physicians, and antacid consumption significantly decreased in H. pylori responder subjects compared with reference subjects (P < 0.05).


CONCLUSIONS
These data suggest that an H. pylori test-and-treat strategy in occupational medicine is effective for improving uninvestigated dyspepsia and quality of life and it may reduce dyspepsia related health care costs at a level of occupational medicine.
Madisch
Ahmed
A
Department of Gastroenterology, General Hospital Celle, Germany.
Hotz
Jürgen
J
Grabowski
Gabriele
G
Guth
Angelika
A
Malfertheiner
Peter
P
Plein
Klaus
K
Schneider
Berthold
B
D000328:Adult; D002908:Chronic Disease; D017281:Cost of Illness; D004359:Drug Therapy, Combination; D004415:Dyspepsia / Q000188:drug therapy* / Q000382:microbiology*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016272:Occupational Health; D011788:Quality of Life