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Volume 339:1869-1874 December 24, 1998 Number 26 Next

	Full Text PDF Editorial by Friedman, L. S. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background The eradication of Helicobacter pylori infection is beneficial in patients with gastric or duodenal ulcers. The value of eradicating the infection in patients with dyspepsia and no evidence of ulcer disease is not known.

Methods We performed a randomized, placebo-controlled trial comparing the efficacy of treatment for two weeks with 20 mg of omeprazole orally twice daily, 500 mg of amoxicillin three times daily (with 500 mg of tetracycline three times daily substituted for amoxicillin in patients allergic to penicillin), and 400 mg of metronidazole three times daily (160 patients) with that of omeprazole alone (158 patients) for resolving symptoms of dyspepsia in patients with H. pylori infection but no evidence of ulcer disease on upper gastrointestinal endoscopy. Symptoms were assessed with the Glasgow Dyspepsia Severity Score, with resolution of symptoms defined as a score of 0 or 1 in the preceding six months (maximal score, 20). One year later the patients were assessed to determine the frequency of the resolution of symptoms.

Results One month after the completion of treatment, 132 of 150 patients (88 percent) in the group assigned to receive omeprazole and antibiotics had a negative test for H. pylori, as compared with 7 of 152 (5 percent) in the group assigned to receive omeprazole alone. One year later, dyspepsia had resolved in 33 of 154 patients (21 percent) in the group given omeprazole and antibiotics, as compared with 11 of 154 (7 percent) in the group given omeprazole alone (95 percent confidence interval for the difference, 7 to 22 percent; P<0.001). Among the patients in the group given omeprazole and antibiotics, the symptoms resolved in 26 of the 98 patients (27 percent) who had had symptoms for five years or less, as compared with 7 of the 56 patients (12 percent) who had had symptoms for more than five years (P=0.03).

Conclusions In patients with H. pylori infection and nonulcer, or functional, dyspepsia, treatment with omeprazole and antibiotics to eradicate the infection is more likely to resolve symptoms than treatment with omeprazole alone.

Source Information

From the Departments of Medicine and Therapeutics (K.M., L.M., E.E.-O., A.D., A.E.-N., A.W., A.K.) and Clinical Physics (T.H.), Western Infirmary; Victoria Infirmary (C.P.); and the Department of Public Health, University of Glasgow (R.K.-J.) — all in Glasgow, United Kingdom.

Address reprint requests to Dr. McColl at the Department of Medicine and Therapeutics, Western Infirmary, Glasgow G11 6NT, United Kingdom.

Full Text of this Article

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Helicobacter pylori and Nonulcer Dyspepsia
Lieber C. S., Puspok A., Oberhuber G., Logan R. F.A., Logan R. P.H., Ganz P. A., Scott B. B., McColl K. E.L., Murray L. S., El-Omar E. M., Blum A. L., Talley N. J., Stolte M., Friedman L. S.
Extract | Full Text  
N Engl J Med 1999; 340:1508-1511, May 13, 1999. Correspondence

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