Eradication of Helicobacter pylori improves symptoms of functional dyspepsia?

Introduction Functional dyspepsia (FD) is a chronic disease that is difficult to treat
.

The role of Helicobacter pylori (Hp) infection in the pathogenic factors of FD is unclear
.

Previous studies have shown that H.
pylori eradication therapy is beneficial to FD.
On this basis, Gut (impact factor 23.
059) recently released a Meta-analysis to evaluate the effect of H.
pylori eradication therapy on the improvement and cure of FD symptoms, as well as definitive eradication.
possible benefits of H.
pylori
.

Methods We searched the medical literature through October 2021 for randomised controlled trials (RCTs) evaluating the efficacy of H.
pylori eradication therapy in H.
pylori-positive adult patients with FD
.

A total of 3625 patients were randomized to receive H.
pylori eradication therapy, and 3156 controls received acid-suppressive therapy or prokinetics, with or without placebo antibiotics, or placebo alone
.

Follow-up time ≥ 3 months
.

Dichotomous data were pooled to obtain relative risk (RR) and 95% CI for not being cured or not improving
.

A total of 29 RCTs were included, including 6781 Hp-positive FD patients
.

1.
Hp eradication therapy has significant benefits in both symptomatic improvement and cure of FD.
A total of 18 RCTs evaluated the cure of FD symptoms, including 4564 Hp-positive FD patients, of whom 2432 received Hp eradication therapy
.

The RR for symptom not cured in FD patients receiving H.
pylori eradication was 0.
91 (95% CI 0.
88-0.
94) compared with controls (Figure 1)
.

Figure 1 The effect of Hp eradication therapy on the cure of FD symptoms.
Twenty-two studies evaluated the improvement of FD symptoms, randomizing 5193 Hp-positive FD patients, of whom 2824 received Hp eradication therapy
.

The RR for no improvement in FD symptoms after H.
pylori eradication treatment was 0.
84 (95% CI 0.
78-0.
91) compared with controls (Figure 2)
.

Figure 2 The effect of H.
pylori eradication therapy on the improvement of FD symptoms 2.
Evaluating the effect of H.
pylori eradication therapy on FD symptoms according to H.
Coefficient = -0.
23, p = 0.
907), but the RR for uncured or unimproved symptoms in patients with successful Hp eradication vs.
unsuccessful FD was 0.
65 (95% CI 0.
52-0.
82)
.

3.
Adverse event assessment Eight RCTs (including 1937 patients) reported total adverse events
.

Overall, adverse events were significantly more common with H.
pylori eradication therapy (RR=2.
19; 95%CI 1.
10-4.
37)
.

Eighteen studies (including 3694 patients) reported discontinuation due to adverse events, and the likelihood of discontinuation due to adverse events was also significantly higher in H.
pylori eradication therapy (RR=2.
60; 95%CI 1.
47-4.
58)
.

Conclusions This meta-analysis provides high-quality evidence that Hp eradication therapy is an effective treatment for Hp-positive FD patients and should therefore be used as a first-line treatment for such patients
.

It remains unclear how H.
pylori eradication therapy benefits FD treatment
.

Future studies should consider evaluating the efficacy of H.
pylori eradication therapy in FD patients without H.
pylori infection
.

Reference: Ford AC, Tsipotis E, Yuan Y, et al.
Efficacy of Helicobacter pylori eradication therapy for functional dyspepsia: updated systematic review and meta-analysis[J].
Gut.
2022 Jan 12:gutjnl-2021-326583.
doi: 10.
1136/gutjnl-2021-326583.