Assessment of symptomatic response as predictor ofHelicobacter pylori status following eradication therapy in patients with ulcer

Abstract

Background—Helicobacter 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.