Helicobacter pylori and nonmalignant diseases.
Eradication of Helicobacter pylori has lead to a significant decrease in the prevalence of peptic ulcer disease world-wide. Despite the fact that H. pylori eradication is the only way to cure peptic ulcer disease, a substantial number of patients still need antisecretory agents to be symptoms-free after eradication. During the past year several randomized controlled trials on H. pylori eradication in patients taking NSAIDs have been published but contradictory results have been obtained. In certain parts of the world, NSAIDs are becoming the main cause of peptic ulcer disease complications such as bleeding or perforation. Some patients with nonulcer dyspepsia do benefit from eradication of H. pylori as was shown in several studies. Long-term trials with cost/efficacy analysis are still needed to demonstrate the benefit of H. pylori eradication over acid inhibition in this group of patients. H. pylori prevalence is lower in patients with gastro-esophageal reflux disease, but according to recent systematic reviews it varies geographically. There are more data now to show that eradication of H. pylori in duodenal ulcer patients does not increase the incidence of GERD. The 'test and treat' strategy for patients with uninvestigated dyspepsia was strongly supported by both meta-analysis and the results of recent randomized controlled trials. Even in developed countries where the prevalence of H. pylori decreases, this strategy allows resolution of symptoms in a larger number of patients with dyspepsia compared to empirical treatment with proton pump inhibitors and reduces the endoscopic workload.
Isakov
Vassili
V
Department of Gastroenterology, Moscow Regional Research Clinical Institute (MONIKI), Moscow, Russia. Vassili.Isakov@rambler.ru
Malfertheiner
Peter
P
D004415:Dyspepsia / Q000453:epidemiology / Q000382:microbiology; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000382:microbiology*; D016481:Helicobacter Infections / Q000150:complications* / Q000453:epidemiology; D016480:Helicobacter pylori; D006801:Humans; D015995:Prevalence; D013276:Stomach Ulcer / Q000453:epidemiology / Q000382:microbiology*