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CAN WE ALWAYS PREVENT DYSPEPTIC SYMPTOMS WITH HELICOBACTER PYLORI ERADICATION IN PEPTIC ULCER PATIENTS

INTRODUCTION: The eradication of H.pylori now become essential in treatment of many gastroduodenal disorders, but very often have been proven to be difficult. H.pylori eradication failure generally concerns between 10 and 30% of the patients. The eradication is known to be of proven benefit for reduction of ulcer recurrences, but significant improvement of the clinical outcome and dyspeptic symptoms has to be measured. AIMS & METHODS: We investigated the possible relationship between H. pylori eradication and dyspeptic symptoms in two patients groups - with and without successful H. pylori eradication, after two or more years. A total of 186 HP-positive patients (96F/90M ; age 54.5, range 21-79) with peptic ulcer (83%) or chr.gastritis (17%), who were successfully eradicated (Group A), were followed for at least 2 years (range, 2-8 years). Another 63 age- and disease-matched H. pylori-positive controls (33F/30M ; age 56, 7, range 24-81, peptic ulcer - 81%, chr.gastritis - 19%), without successful eradication, only on symptomatic therapy, were also enrolled (Group B). Symptomatic status was defined as the percentage of patients with significant epigastric pain and heartburn (GERD) symptoms. Endoscopy with histology was performed on every control. RESULTS: (Table) There were no significant differences in symptoms improvement between two groups for epigastric pain, despite fact that ulcer recurrence was only 6, 4% in group A and 67% in group B (p < 0, 0001). Reflux esophagitis symptoms incidence was significantly higher in eradicated group (p < 0, 05), especially after four years. TABLE 1: Group Years after inclusion A 0 1 2 3 4 5 or more No. patients 186 180 159 121 86 95 Pain 69, 5% 32, 2% 47, 8% 53, 7% 54, 7% 55, 8% GERD 19, 9% 11, 7% 22, 1% 23, 1% 20, 9% 38, 9% B No. patients 63 61 58 28 8 6 Pain 67, 2% 39, 3% 37, 9% 50, 0% 50, 0% 50, 0% GERD 15, 5% 8, 2% 10, 3% 21, 4% 12, 5% 16, 7% CONCLUSION: Although treatment of H. pylori infection is useful in preventing ulcer recurrence, as we expected, symptomatic improvement can be achieved with good antisecretory therapy as well. As almost half of patients suffered from epigastric pain despite ulcers healing and HP-eradication, our results can suggest coexistence of dyspepsia in peptic ulcer patients. Reflux esophagitis symptoms incidence was significantly higher in eradicated group, especially four years after eradication.

Helicobacter pylori; dyspepsia; eradication

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