H. pylori eradication therapy may lead to better outcomes for functional dyspepsia

Eradication therapy for Helicobacter pylori may be effective for improving functional dyspepsia symptoms and cure rates, according to a recent systematic review and meta-analysis.

Researchers examined the medical literature through October 2021 to identify randomized controlled trials comparing the efficacy of eradication therapy versus antisecretory therapy or prokinetics, with or without placebo antibiotics, or a placebo alone in adults with functional dyspepsia who had tested positive for H. pylori infection. The primary outcome was the effect of H. pylori eradication therapy on cure or improvement of functional dyspepsia, while secondary outcomes included the effect of H. pylori eradication therapy on functional dyspepsia symptoms according to eradication rates, success or failure of eradication therapy and antibiotics used, and adverse events due to therapy or leading to study withdrawal. The results were published Jan. 12 by Gut.

The study included 29 trials with 6,781 patients, with follow-up of at least three months. Overall, 3,625 patients were assigned to receive H. pylori eradication therapy and 3,156 were assigned to receive control therapy. Eradication therapy was superior to control for both cure of functional dyspepsia symptoms (relative risk [RR] for no cure, 0.91 [95% CI, 0.88 to 0.94]; number needed to treat, 14 [95% CI, 11 to 21]) and symptom improvement (RR for no improvement, 0.84 [95% CI, 0.78 to 0.91]; number needed to treat, 9 [95% CI, 7 to 17]). While no significant correlation was seen between eradication rate and relative risk of improvement or cure, a larger effect size was noted in those with successful versus unsuccessful eradication (RR, 0.65 [95% CI, 0.52 to 0.82]; number needed to treat, 4.5 [95% CI, 3 to 9]). Adverse events and adverse events leading to study withdrawal were both more common in patients receiving eradication therapy (RR, 2.19 [95% CI, 1.10 to 4.37] and 2.60 [95% CI, 1.47 to 4.58], respectively).

The authors noted that the intervention and control regimens differed among the included trials and that adverse events were often not reported, among other limitations. They concluded that H. pylori eradication therapy can improve or cure symptoms of functional dyspepsia and that it should be considered first-line therapy in H. pylori-positive patients with this disorder. Future randomized controlled trials should assess the efficacy of this therapy in patients who have functional dyspepsia without H. pylori infection, the authors suggested, since the mechanism of benefit is unclear.