Helicobacter pylori and dyspepsia: A population-based study of the organism and host

OBJECTIVE: The role of Helicobacter pylori (HP) infection in dyspepsia in t he absence of peptic ulcer remains controversial. Specific attributes of th e organism or the host response may be important. We aimed to determine whe ther HP infection overall, CagA status, serum gastrin, or serum pepsinogen levels are associated with dyspepsia in the community. METHODS: A self-report bowel disease questionnaire was mailed to a random s ample of Olmsted County, Minnesota residents, aged 20-50 yr. All respondent s who reported symptoms of dyspepsia or irritable bowel syndrome (cases) an d all respondents without significant GI symptoms (controls) were invited t o participate (n = 260). They were each assessed by a physician and their m edical records reviewed. Serum was obtained to measure HP and CagA antibodi es, pepsinogen I and II levels, and basal serum gastrin using validated ass ays. RESULTS: Of the 148 (57%) subjects who agreed to participate, 36 had dyspep sia (17 had ulcer-like dyspepsia), 35 had irritable bowel syndrome (IBS) wi thout dyspepsia, and 77 were asymptomatic. The proportion who were seroposi tive for HP were 17% in dyspepsia (24% in ulcer-like dyspepsia), 20% in IBS , and 12% in asymptomatic controls. HP was not associated with dyspepsia, u lcer-like dyspepsia, or IBS after adjusting for age. Pepsinogen levels and serum gastrin were not associated with any of the conditions studied. Howev er, CagA antibody positivity was associated with IBS (p < 0.05), and a bord erline statistically significant association with dyspepsia was detected (p = 0.08). CONCLUSIONS: In this community, HP infection overall does not seem to expla in dyspepsia, although the role of CagA-positive HP strains deserve further study. (C) 2000 by Am. Cell. of Gastroenterology.