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Assessment of symptomatic response as predictor ofHelicobacter pylori status following eradication therapy in patients with ulcer
  1. K E L McColl,
  2. A El-Nujumi,
  3. L S Murray,
  4. E M El-Omar,
  5. A Dickson,
  6. A W Kelman,
  7. T E Hilditch
  1. University Department of Medicine and Therapeutics, Western Infirmary, Glasgow G11 6NT, UK
  1. Professor K E L McColl.

Abstract

BackgroundHelicobacter pylorieradication therapy is routinely used for treating patients with peptic ulcer disease.

Aims—To assess the value of symptomatic response to H pylori eradication therapy as a marker of post-treatment H pylori status.

Patients and methods—One hundred and nine dyspeptic patients with active duodenal or gastric ulceration associated with H pylori infection had their symptoms measured by a validated questionnaire before and three months followingH pylori eradication therapy. The symptomatic response was compared with post-treatment H pylori status as determined by the 14C urea breath test.

Results—An eradication rate of 84% was achieved. Of the 92 patients eradicated of H pylori, 47% experienced complete or near complete resolution of dyspepsia. Of the 17 patients in whom the infection was not eradicated, only one (6%) experienced resolution of dyspepsia. Resolution of dyspepsia was therefore a powerful predictor of eradication of H pyloriwith a predictive value of 98%. In contrast, persistence of dyspepsia was a weak predictor of persisting infection with a predictive value of only 25%. Excluding patients with endoscopic evidence of coexisting oesophagitis and/or retrosternal discomfort or reflux at initial presentation did not increase the predictive value of persisting dyspepsia for persisting infection.

Conclusions—Complete resolution of dyspeptic symptoms is a powerful predictor of eradication of H pylori infection in ulcer patients. Persistence of symptoms is a weak predictor of persisting infection and patients with persisting dyspepsia must have their H pylori status rechecked to guide future management.

  • Helicobacter pylori
  • dyspepsia
  • ulcer disease
  • eradication therapy
  • reflux disease

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