title: Impact of Helicobacter pylori infection and microscopic duodenal histopathological changes on clinical symptoms of patients with functional dyspepsia.
abstract: OBJECTIVE
  To evaluate the microscopic histopathological changes in duodenal tissue and its relationship to the severity of symptoms in patients with functional dyspepsia while taking the effect of Helicobacter pylori (H. pylori) infection into account.
  
  
  METHODS
  Several gastric and duodenal biopsy specimens were obtained in 217 patients with functional dyspepsia and were evaluated for H. pylori infection and histopathological changes. Severity of symptoms was assessed by Leeds Dyspepsia Questionnaire (LDQ) and its relationship to histopathological changes and H. pylori infection status was assessed.
  
  
  RESULTS
  Helicobacter pylori infection was associated with presence and severity of microscopic duodenitis (p < 0.001). In H. pylori-infected patients, the presence of microscopic duodenitis was independent of microscopic gastritis (p = 0.74). Severity of dyspepsia symptoms was not higher in H. pylori-infected patients than non-infected patients (p = 0.15), but in the presence of H. pylori infection and microscopic gastritis, microscopic duodenitis significantly worsened the LDQ symptom severity score (p < 0.001). In multivariate analysis, the odds of experiencing severe symptoms in patients with severe microscopic duodenitis was 2.22 times greater than in individuals with very mild, mild, or moderate duodenitis.
  
  
  CONCLUSIONS
  Microscopic duodenitis in H. pylori-infected patients may play a major role in producing and aggravating symptoms in FD patients and may be a determinant factor to consider in whether to treat H. pylori infection in functional dyspepsia.
authors.affiliation: Department of Internal Medicine, Amir-Alam Hospital, School of Medicine, Tehran University of Medical Sciences, North Sa'adi Street, 13145-784 Tehran, Iran.
authors.forename: Seyed Amir
authors.initials: SA
authors.lastname: Mirbagheri
authors.forename: Nasim
authors.initials: N
authors.lastname: Khajavirad
authors.forename: Nasser
authors.initials: N
authors.lastname: Rakhshani
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Ostovaneh
authors.forename: Seyed Mahmood Eshagh
authors.initials: SM
authors.lastname: Hoseini
authors.forename: Vahid
authors.initials: V
authors.lastname: Hoseini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004382:Duodenitis / Q000382:microbiology / Q000473:pathology*; D004386:Duodenum / Q000473:pathology*; D004415:Dyspepsia / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D005756:Gastritis / Q000382:microbiology / Q000473:pathology*; D016481:Helicobacter Infections / Q000150:complications* / Q000473:pathology; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D013270:Stomach / Q000473:pathology; D055815:Young Adult
references.citation: Gastroenterology. 2006 Apr;130(5):1466-79
references.pmid: 16678560
references.citation: Gastroenterology. 1989 Feb;96(2 Pt 2 Suppl):615-25
references.pmid: 2642447
references.citation: BMC Gastroenterol. 2010 Feb 03;10:14
references.pmid: 20128917
references.citation: Dig Dis Sci. 2000 Jun;45(6):1172-9
references.pmid: 10877234
references.citation: J Clin Pathol. 1986 Aug;39(8):863-70
references.pmid: 3528230
references.citation: Gut. 2007 Jun;56(6):772-81
references.pmid: 17170018
references.citation: J Gastroenterol Hepatol. 2011 Apr;26 Suppl 3:39-41
references.pmid: 21443707
references.citation: Gastroenterol Clin North Am. 2000 Dec;29(4):807-18
references.pmid: 11190065
references.citation: Am Fam Physician. 2011 Mar 1;83(5):547-52
references.pmid: 21391521
references.citation: Am J Surg Pathol. 1996 Oct;20(10):1161-81
references.pmid: 8827022
references.citation: Aliment Pharmacol Ther. 2004 Mar 15;19(6):643-54
references.pmid: 15023166
references.citation: J Gastroenterol Hepatol. 2011 Apr;26 Suppl 3:42-5
references.pmid: 21443708
references.citation: J Gastroenterol. 2010 Feb;45(2):187-94
references.pmid: 19997854
references.citation: Gut. 1999 Sep;45 Suppl 2:II37-42
references.pmid: 10457043
references.citation: Cochrane Database Syst Rev. 2000;(2):CD002096
references.pmid: 10796858
references.citation: Eur J Epidemiol. 2009;24(10):649-58
references.pmid: 19629722
references.citation: J Gastrointestin Liver Dis. 2006 Sep;15(3):237-41
references.pmid: 17013448
references.citation: Ann Med. 1995 Oct;27(5):595-9
references.pmid: 8541038
references.citation: J Gastroenterol Hepatol. 2007 Nov;22(11):1706-11
references.pmid: 17914939
references.citation: Aliment Pharmacol Ther. 2002 Mar;16 Suppl 1:3-15
references.pmid: 11849122
references.citation: J Gastroenterol Hepatol. 2001 May;16(5):513-8
references.pmid: 11350546
references.citation: J Gastroenterol Hepatol. 2010 May;25 Suppl 1:S99-S110
references.pmid: 20586876
references.citation: Am Fam Physician. 2004 Jul 1;70(1):107-14
references.pmid: 15259526
references.citation: Hum Pathol. 2010 Nov;41(11):1593-600
references.pmid: 20656325
references.citation: J Clin Gastroenterol. 1995 Mar;20(2):104-9
references.pmid: 7769187
references.citation: Cochrane Database Syst Rev. 2006 Apr 19;(2):CD002096
references.pmid: 16625554
references.citation: Aliment Pharmacol Ther. 1998 Dec;12(12):1257-62
references.pmid: 9882035
references.citation: Dig Dis Sci. 1991 Aug;36(8):1084-8
references.pmid: 1864201
references.citation: Cochrane Database Syst Rev. 2005 Oct 19;(4):CD001961
references.pmid: 16235292