LONG-TERM FOLLOW-UP OF HELICOBACTER-PYLORI TREATMENT IN NONULCER DYSPEPSIA PATIENTS

Background/Aims: It remains controversial whether Helicobacter pylori infection causes symptoms in nonulcer dyspepsia. One hundred non-ulcer dyspepsia patients were screened for H. pylori infection between Nove mber 1989 and February 1994. Forty patients entered a trial where both infected and uninfected patients were treated with H. pylori therapy, with the uninfected group serving as controls. Methods: Non-ulcer dys pepsia was defined as unexplained epigastric discomfort lasting for at least 4 wk. From November 1989 until February 1992, all patients, reg ardless of H. pylori status, were treated with bismuth subsalicylate t ablets (524 mg q.i.d.) for 4 wk and metronidazole (250 mg q.i.d.) for the first 2 of the 4 wk. From March 1992 until February 1994, only inf ected patients were treated in an attempt to obtain equal numbers in e ach group. H. pylori infection was diagnosed histologically at the ind ex endoscopy and 1 month after completion of therapy. Symptoms were sc ored on a 0-5 scale for both frequency and severity. Results: Of 100 p atients screened, 33 were infected with H. pylori (mean age, 42; 10 me n, 23 women), and 67 were uninfected (mean age, 38; 16 men, 51 women). Thirty-six uninfected patients were not offered treatment during the latter part of the trial. Of the remaining 31 uninfected patients, 10 dropped out; of the 33 infected patients, 14 dropped out. Twenty-one u ninfected patients and 19 H. pylori-infected patients completed treatm ent; in 13 of 19 patients (68%), H. pylori was eradicated. Symptoms im proved in eight of 13 (61%) H. pylori-eradicated patients and in four of six (66%) H. pylori-persistent patients, compared with 14 of 21 (66 %) uninfected patients. Long-term follow-up (mean, 34 months) showed s imilar symptom outcome in the two treatment groups. Conclusions: Thirt y-three percent of our non-ulcer dyspepsia patients were infected with H. pylori, a number similar to the percentage of infected age-matched controls in the U.S. Treatment with bismuth subsalicylate and metroni dazole resulted in symptomatic improvement in 61-66% of non-ulcer dysp epsia patients regardless of initial or post-treatment H. pylori statu s. Long-term symptom follow-up in both the control and infected groups gave similar results. H. pylori infection is not related to the sympt oms of non-ulcer dyspepsia.