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No H pylori: less dyspepsia?
  1. K E L McCOLL
  1. Department of Medicine and Therapeutics
  2. Gardiner Institute, Western Infirmary
  3. Glasgow G11 6NT, UK
  4. Email:

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See article on page 473

Functional dyspepsia is a common disorder of heterogeneous aetiology for which there is no clearly effective treatment. In this issue of Gut, Blum and colleagues1 report their large controlled clinical trial assessing the effectiveness of antisecretory medication in functional dyspepsia (see page 473). Patients with and without evidence ofHelicobacter pylori infection were recruited into the study.

The study found symptomatic benefit over placebo at the end of two weeks' treatment with omeprazole 20 mg per day inH pylori positive patients but no significant benefit in primary outcome with the same treatment inH pylori negative patients. The therapeutic gain over placebo for omeprazole 20 mg in the H pylori positive patients was 17.6% (95% confidence intervals 4.2–31%; p<0.014). There was no significant benefit over placebo following omeprazole 10 mg or ranitidine 150 mg inH pylori positive patients or following any of the three treatments in the H pylorinegative subjects. The superior benefit from omeprazole 20 mg in theH pylori positive versus negative subjects was also apparent with respect to improvement in quality of life.

The reason for symptomatic benefit over placebo with powerful acid suppression being confined to the H pyloriinfected subjects in this study is unclear and needs to be addressed. An earlier large …

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