Skip to main content
PMC home page
The British Journal of General Practice logoLink to The British Journal of General Practice
. 1995 Sep;45(398):489–494.

Role of Helicobacter pylori in gastrointestinal disease: implications for primary care of a revolution in management of dyspepsia.

B C Delaney 1
PMCID: PMC1239374  PMID: 7546874

Abstract

The majority of patients with dyspepsia are managed in general practice. However, most of the literature on Helicobacter pylori and its association with gastrointestinal disease has originated from secondary care. This review summarizes the role of H pylori in dyspepsia from the perspective of primary care and suggests a new strategy for the management of dyspeptic patients in this setting. Recent meta-analyses and consensus statements have supported the use of eradication therapy as first-line treatment of peptic ulceration. Studies from primary care have supported the use of eradication therapy in patients who have H pylori related peptic ulcer disease and require long-term H2-antagonist medication, on both clinical benefit and cost-effectiveness grounds. Of the many regimens proposed for the eradication of H pylori, the best evidence supports a triple combination of bismuth, metronidazole and tetracycline. Regimens using proton pump inhibitors may be more acceptable to patients but lack good evidence from trials. Use of a positive serum enzyme-linked immunoabsorbent assay for H pylori antibodies as a criterion for endoscopic investigation has been shown to result in a 23% reduction in endoscopic workload. Further research should answer questions of importance to general practitioners, such as the role of eradication therapy in patients with nonulcer dyspepsia and the effectiveness of eradication of H pylori in the prevention of gastric cancer.

Full text

PDF
489

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. An international association between Helicobacter pylori infection and gastric cancer. The EUROGAST Study Group. Lancet. 1993 May 29;341(8857):1359–1362. [PubMed] [Google Scholar]
  2. Axon A. T. Helicobacter pylori infection. J Antimicrob Chemother. 1993 Jul;32 (Suppl A):61–68. doi: 10.1093/jac/32.suppl_a.61. [DOI] [PubMed] [Google Scholar]
  3. Axon A. T. The role of acid inhibition in the treatment of Helicobacter pylori infection. Scand J Gastroenterol Suppl. 1994;201:16–23. [PubMed] [Google Scholar]
  4. Bayerdörffer E., Mannes G. A., Sommer A., Höchter W., Weingart J., Hatz R., Lehn N., Ruckdeschel G., Dirschedl P., Stolte M. Long-term follow-up after eradication of Helicobacter pylori with a combination of omeprazole and amoxycillin. Scand J Gastroenterol Suppl. 1993;196:19–25. doi: 10.3109/00365529309098337. [DOI] [PubMed] [Google Scholar]
  5. Beavis A. K., La Brooy S., Misiewicz J. J. Evaluation of one-visit endoscopic clinic for patients with dyspepsia. Br Med J. 1979 May 26;1(6175):1387–1389. doi: 10.1136/bmj.1.6175.1387. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Bell G. D., Powell K. U., Burridge S. M., Bowden A. N., Rameh B., Bolton G., Purser K., Harrison G., Brown C., Gant P. W. Helicobacter pylori eradication: efficacy and side effect profile of a combination of omeprazole, amoxycillin and metronidazole compared with four alternative regimens. Q J Med. 1993 Nov;86(11):743–750. [PubMed] [Google Scholar]
  7. Bell G. D., Powell K. U. Eradication of Helicobacter pylori and its effect in peptic ulcer disease. Scand J Gastroenterol Suppl. 1993;196:7–11. doi: 10.3109/00365529309098334. [DOI] [PubMed] [Google Scholar]
  8. Bernersen B., Johnsen R., Bostad L., Straume B., Sommer A. I., Burhol P. G. Is Helicobacter pylori the cause of dyspepsia? BMJ. 1992 May 16;304(6837):1276–1279. doi: 10.1136/bmj.304.6837.1276. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Bramble M. G. Open access endoscopy--a nationwide survey of current practice. Gut. 1992 Feb;33(2):282–285. doi: 10.1136/gut.33.2.282. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Chiba N., Rao B. V., Rademaker J. W., Hunt R. H. Meta-analysis of the efficacy of antibiotic therapy in eradicating Helicobacter pylori. Am J Gastroenterol. 1992 Dec;87(12):1716–1727. [PubMed] [Google Scholar]
  11. Coghlan J. G., Gilligan D., Humphries H., McKenna D., Dooley C., Sweeney E., Keane C., O'Morain C. Campylobacter pylori and recurrence of duodenal ulcers--a 12-month follow-up study. Lancet. 1987 Nov 14;2(8568):1109–1111. doi: 10.1016/s0140-6736(87)91545-5. [DOI] [PubMed] [Google Scholar]
  12. Collins R., Beattie S., Xia H. X., O'Morain C. Short report: high-dose omeprazole and amoxycillin in the treatment of Helicobacter pylori-associated duodenal ulcer. Aliment Pharmacol Ther. 1993 Jun;7(3):313–315. doi: 10.1111/j.1365-2036.1993.tb00102.x. [DOI] [PubMed] [Google Scholar]
  13. Correa P., Fox J., Fontham E., Ruiz B., Lin Y. P., Zavala D., Taylor N., Mackinley D., de Lima E., Portilla H. Helicobacter pylori and gastric carcinoma. Serum antibody prevalence in populations with contrasting cancer risks. Cancer. 1990 Dec 15;66(12):2569–2574. doi: 10.1002/1097-0142(19901215)66:12<2569::aid-cncr2820661220>3.0.co;2-i. [DOI] [PubMed] [Google Scholar]
  14. Cutler A. F., Schubert T. T. Patient factors affecting Helicobacter pylori eradication with triple therapy. Am J Gastroenterol. 1993 Apr;88(4):505–509. [PubMed] [Google Scholar]
  15. Desai H. G., Gill H. H., Shankaran K., Mehta P. R., Prabhu S. R. Dental plaque: a permanent reservoir of Helicobacter pylori? Scand J Gastroenterol. 1991 Nov;26(11):1205–1208. doi: 10.3109/00365529108998615. [DOI] [PubMed] [Google Scholar]
  16. Forman D., Newell D. G., Fullerton F., Yarnell J. W., Stacey A. R., Wald N., Sitas F. Association between infection with Helicobacter pylori and risk of gastric cancer: evidence from a prospective investigation. BMJ. 1991 Jun 1;302(6788):1302–1305. doi: 10.1136/bmj.302.6788.1302. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Fox J. G., Correa P., Taylor N. S., Thompson N., Fontham E., Janney F., Sobhan M., Ruiz B., Hunter F. High prevalence and persistence of cytotoxin-positive Helicobacter pylori strains in a population with high prevalence of atrophic gastritis. Am J Gastroenterol. 1992 Nov;87(11):1554–1560. [PubMed] [Google Scholar]
  18. Frazzoni M., Lonardo A., Grisendi A., Della Casa G., Pulvirenti M., Ferrari A. M., Di Gregorio C., Melini L. Are routine duodenal and antral biopsies useful in the management of "functional" dyspepsia? A diagnostic and therapeutic study. J Clin Gastroenterol. 1993 Sep;17(2):101–108. doi: 10.1097/00004836-199309000-00004. [DOI] [PubMed] [Google Scholar]
  19. Gad A., Unge P. Antibacterial therapy of Helicobacter pylori-associated peptic ulcer disease: a new strategy. The Swedes go for it. J Clin Gastroenterol. 1994 Jul;19(1):6–10. doi: 10.1097/00004836-199407000-00003. [DOI] [PubMed] [Google Scholar]
  20. George L. L., Borody T. J., Andrews P., Devine M., Moore-Jones D., Walton M., Brandl S. Cure of duodenal ulcer after eradication of Helicobacter pylori. Med J Aust. 1990 Aug 6;153(3):145–149. doi: 10.5694/j.1326-5377.1990.tb136833.x. [DOI] [PubMed] [Google Scholar]
  21. Goh K. L., Parasakthi N., Peh S. C., Wong N. W., Lo Y. L., Puthucheary S. D. Helicobacter pylori infection and non-ulcer dyspepsia: the effect of treatment with colloidal bismuth subcitrate. Scand J Gastroenterol. 1991 Nov;26(11):1123–1131. doi: 10.3109/00365529108998603. [DOI] [PubMed] [Google Scholar]
  22. Hallissey M. T., Allum W. H., Jewkes A. J., Ellis D. J., Fielding J. W. Early detection of gastric cancer. BMJ. 1990 Sep 15;301(6751):513–515. doi: 10.1136/bmj.301.6751.513. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Hungin A. P., Thomas P. R., Bramble M. G., Corbett W. A., Idle N., Contractor B. R., Berridge D. C., Cann G. What happens to patients following open access gastroscopy? An outcome study from general practice. Br J Gen Pract. 1994 Nov;44(388):519–521. [PMC free article] [PubMed] [Google Scholar]
  24. Hunt R. H. pH and Hp--gastric acid secretion and Helicobacter pylori: implications for ulcer healing and eradication of the organism. Am J Gastroenterol. 1993 Apr;88(4):481–483. [PubMed] [Google Scholar]
  25. Jones R. What happens to patients with non-ulcer dyspepsia after endoscopy? Practitioner. 1988 Jan;232(1441):75-6, 78. [PubMed] [Google Scholar]
  26. Jones S. T., Clague R. B., Eldridge J., Jones D. M. Serological evidence of infection with Helicobacter pylori may predict gastrointestinal intolerance to non-steroidal anti-inflammatory drug (NSAID) treatment in rheumatoid arthritis. Br J Rheumatol. 1991 Feb;30(1):16–20. doi: 10.1093/rheumatology/30.1.16. [DOI] [PubMed] [Google Scholar]
  27. Jönsson B. Economic evaluation of new medical technology. Scand J Gastroenterol Suppl. 1994;201:87–90. doi: 10.3109/00365529409105372. [DOI] [PubMed] [Google Scholar]
  28. Korman M. G. Quality of Life in duodenal ulcer. Scand J Gastroenterol Suppl. 1993;199:28–31. doi: 10.3109/00365529309098352. [DOI] [PubMed] [Google Scholar]
  29. Labenz J., Gyenes E., Rühl G. H., Börsch G. Amoxicillin plus omeprazole versus triple therapy for eradication of Helicobacter pylori in duodenal ulcer disease: a prospective, randomized, and controlled study. Gut. 1993 Sep;34(9):1167–1170. doi: 10.1136/gut.34.9.1167. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Labenz J., Rühl G. H., Bertrams J., Börsch G. Effective treatment after failure of omeprazole plus amoxycillin to eradicate Helicobacter pylori infection in peptic ulcer disease. Aliment Pharmacol Ther. 1994 Jun;8(3):323–327. doi: 10.1111/j.1365-2036.1994.tb00295.x. [DOI] [PubMed] [Google Scholar]
  31. Lobo A., Dickinson R. Managing the dyspeptic patient: experience of a single-visit dyspepsia clinic. J R Soc Med. 1988 Apr;81(4):212–213. doi: 10.1177/014107688808100409. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Logan R. P., Gummett P. A., Schaufelberger H. D., Greaves R. R., Mendelson G. M., Walker M. M., Thomas P. H., Baron J. H., Misiewicz J. J. Eradication of Helicobacter pylori with clarithromycin and omeprazole. Gut. 1994 Mar;35(3):323–326. doi: 10.1136/gut.35.3.323. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Mann J., Holdstock G., Harman M., Machin D., Loehry C. A. Scoring system to improve cost effectiveness of open access endoscopy. Br Med J (Clin Res Ed) 1983 Oct 1;287(6397):937–940. doi: 10.1136/bmj.287.6397.937. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. McQuaid K. R. Endoscopy-negative dyspepsia. Hold those forceps! J Clin Gastroenterol. 1993 Sep;17(2):97–100. [PubMed] [Google Scholar]
  35. Neeman A., Kadish U. Selection of patients for treatment of duodenal ulcer infected with Helicobacter pylori. J Clin Gastroenterol. 1994 Jul;19(1):17–19. doi: 10.1097/00004836-199407000-00005. [DOI] [PubMed] [Google Scholar]
  36. Noach L. A., Langenberg W. L., Bertola M. A., Dankert J., Tytgat G. N. Impact of metronidazole resistance on the eradication of Helicobacter pylori. Scand J Infect Dis. 1994;26(3):321–327. doi: 10.3109/00365549409011802. [DOI] [PubMed] [Google Scholar]
  37. O'Connor H. J. Eradication of Helicobacter pylori: therapies and clinical implications. Postgrad Med J. 1992 Jul;68(801):549–557. doi: 10.1136/pgmj.68.801.549. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. O'Moráin C., Gilvarry J. Eradication of Helicobacter pylori in patients with non-ulcer dyspepsia. Scand J Gastroenterol Suppl. 1993;196:30–33. doi: 10.3109/00365529309098340. [DOI] [PubMed] [Google Scholar]
  39. Oxman A. D. Checklists for review articles. BMJ. 1994 Sep 10;309(6955):648–651. doi: 10.1136/bmj.309.6955.648. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Oxman A. D., Sackett D. L., Guyatt G. H. Users' guides to the medical literature. I. How to get started. The Evidence-Based Medicine Working Group. JAMA. 1993 Nov 3;270(17):2093–2095. [PubMed] [Google Scholar]
  41. Parsonnet J., Blaser M. J., Perez-Perez G. I., Hargrett-Bean N., Tauxe R. V. Symptoms and risk factors of Helicobacter pylori infection in a cohort of epidemiologists. Gastroenterology. 1992 Jan;102(1):41–46. doi: 10.1016/0016-5085(92)91782-y. [DOI] [PubMed] [Google Scholar]
  42. Parsonnet J., Friedman G. D., Vandersteen D. P., Chang Y., Vogelman J. H., Orentreich N., Sibley R. K. Helicobacter pylori infection and the risk of gastric carcinoma. N Engl J Med. 1991 Oct 17;325(16):1127–1131. doi: 10.1056/NEJM199110173251603. [DOI] [PubMed] [Google Scholar]
  43. Patchett S., Beattie S., Leen E., Keane C., O'Morain C. Eradicating Helicobacter pylori and symptoms of non-ulcer dyspepsia. BMJ. 1991 Nov 16;303(6812):1238–1240. doi: 10.1136/bmj.303.6812.1238. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Peura D. A., Graham D. Y. Helicobacter pylori: consensus reached: peptic ulcer is on the way to becoming an historic disease. Am J Gastroenterol. 1994 Aug;89(8):1137–1139. [PubMed] [Google Scholar]
  45. Pronovost A. D., Rose S. L., Pawlak J. W., Robin H., Schneider R. Evaluation of a new immunodiagnostic assay for Helicobacter pylori antibody detection: correlation with histopathological and microbiological results. J Clin Microbiol. 1994 Jan;32(1):46–50. doi: 10.1128/jcm.32.1.46-50.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Rauws E. A., Tytgat G. N. Cure of duodenal ulcer associated with eradication of Helicobacter pylori. Lancet. 1990 May 26;335(8700):1233–1235. doi: 10.1016/0140-6736(90)91301-p. [DOI] [PubMed] [Google Scholar]
  47. Rokkas T., Pursey C., Uzoechina E., Dorrington L., Simmons N. A., Filipe M. I., Sladen G. E. Non-ulcer dyspepsia and short term De-Nol therapy: a placebo controlled trial with particular reference to the role of Campylobacter pylori. Gut. 1988 Oct;29(10):1386–1391. doi: 10.1136/gut.29.10.1386. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Ryder S. D., O'Reilly S., Miller R. J., Ross J., Jacyna M. R., Levi A. J. Long term acid suppressing treatment in general practice. BMJ. 1994 Mar 26;308(6932):827–830. doi: 10.1136/bmj.308.6932.827. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Safe A. F., Warren B., Corfield A., McNulty C. A., Watson B., Mountford R. A., Read A. Helicobacter pylori infection in elderly people: correlation between histology and serology. Age Ageing. 1993 May;22(3):215–220. doi: 10.1093/ageing/22.3.215. [DOI] [PubMed] [Google Scholar]
  50. Sipponen P. Gastric cancer--a long-term consequence of Helicobacter pylori infection? Scand J Gastroenterol Suppl. 1994;201:24–27. [PubMed] [Google Scholar]
  51. Sipponen P., Hyvärinen H. Role of Helicobacter pylori in the pathogenesis of gastritis, peptic ulcer and gastric cancer. Scand J Gastroenterol Suppl. 1993;196:3–6. doi: 10.3109/00365529309098333. [DOI] [PubMed] [Google Scholar]
  52. Sipponen P., Riihelä M., Hyvärinen H., Seppälä K. Chronic nonatropic ('superficial') gastritis increases the risk of gastric carcinoma. A case-control study. Scand J Gastroenterol. 1994 Apr;29(4):336–340. doi: 10.3109/00365529409094845. [DOI] [PubMed] [Google Scholar]
  53. Sobala G. M., Crabtree J. E., Pentith J. A., Rathbone B. J., Shallcross T. M., Wyatt J. I., Dixon M. F., Heatley R. V., Axon A. T. Screening dyspepsia by serology to Helicobacter pylori. Lancet. 1991 Jul 13;338(8759):94–96. doi: 10.1016/0140-6736(91)90085-4. [DOI] [PubMed] [Google Scholar]
  54. Thomas J. E., Gibson G. R., Darboe M. K., Dale A., Weaver L. T. Isolation of Helicobacter pylori from human faeces. Lancet. 1992 Nov 14;340(8829):1194–1195. doi: 10.1016/0140-6736(92)92894-l. [DOI] [PubMed] [Google Scholar]
  55. Unidentified curved bacilli on gastric epithelium in active chronic gastritis. Lancet. 1983 Jun 4;1(8336):1273–1275. [PubMed] [Google Scholar]
  56. Veldhuyzen van Zanten S. J. A systematic overview (meta-analysis) of outcome measures in Helicobacter pylori gastritis trials and functional dyspepsia. Scand J Gastroenterol Suppl. 1993;199:40–43. doi: 10.3109/00365529309098356. [DOI] [PubMed] [Google Scholar]
  57. Veldhuyzen van Zanten S. J., Sherman P. M. Indications for treatment of Helicobacter pylori infection: a systematic overview. CMAJ. 1994 Jan 15;150(2):189–198. [PMC free article] [PubMed] [Google Scholar]
  58. Webb P. M., Knight T., Greaves S., Wilson A., Newell D. G., Elder J., Forman D. Relation between infection with Helicobacter pylori and living conditions in childhood: evidence for person to person transmission in early life. BMJ. 1994 Mar 19;308(6931):750–753. doi: 10.1136/bmj.308.6931.750. [DOI] [PMC free article] [PubMed] [Google Scholar]
  59. Williams B., Luckas M., Ellingham J. H., Dain A., Wicks A. C. Do young patients with dyspepsia need investigation? Lancet. 1988 Dec 10;2(8624):1349–1351. doi: 10.1016/s0140-6736(88)90879-3. [DOI] [PubMed] [Google Scholar]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners

RESOURCES