Relationship Between H. Pylori Infection And Improvement Of Different Subtypes Of Functional Dyspepsia

BACKGROUND:Functional Dyspepsia(FD)is a highly symptom complex that may be subdivided into postprandial distress syndrome(PDS) and epigastric pain syndrome(EPS) according to the Rome III Criteria. The relationship between Helicobacter pylori (H. pylori) infection and FD is uncertain. The FD patients with H. pylori infection need to eradicate H. pylori or not, whether eradication of H. pylori would relieve the symptoms in dyspepsia and whether this improvement is associated with the different subtypes of FD remains controversial.AIM: To inquire the drug therapeutic effection on PDS and EPS of patients with FD. METHODS: seventy-seven patients with documented PDS and EPS based on Rome III Criteria of FD were enrolled in the study. The patients with H. pylori infection receiving gastroendoscopy were randomly allocated into two groups: eradication group and non-eradication group. Eradication group were with anti-H. pylori triple therapy (Esomeprazole 20 mg bid, clarithromycin 500 mg bid, amoxil 1.0g bid), for 10 days, and then treated with Domperidone 10mg tid (PDS group) or Talcid 1.0g tid (EPS group) , for 4 days. Non-eradication group and H. pylori non-infection group were treated with Domperidone 10mg tid (PDS group) or Talcid 1.0g tid (EPS group) ,for 14 days. 14C-Urea Breath Test (14C-UBT) was taken in the detection of H. pylori infection in eradication group after one month. Six months after treatment the symptom scores in groups were compared.RESULTS: The infection in FD patients were 52.9%, H. pylori was eradicated in 19 cases and remained positive in 3 cases. In successful eradication group, the total symptoms score significantly reduced in both PDS (P=0.025) and EPS groups (P=0.008). In non-eradication group and H. pylori non-infection group, the total symptoms score significantly reduced in PDS group (non-eradication group: P=0.001; H. pylori non-infection group: P=0.000) but not in EPS group (non-eradication group: P=0.055; H. pylori non-infection group: P=0.052). In PDS group, although there was no statistically significant discrepancy on degree of symptoms improvement between successful eradication group and non-eradication group, a tendency for symptoms to be more relieved has been observed in non-eradication group(P=0.063).CONCLUSION: Both triple and conventional therapy improves the clinical symptoms of PDS in FD patients with H. pylori infection and conventional therapy showed better symptoms relief effect. Triple therapy seems to be benefit to EPS in FD patients with H. pylori infection.