Role of H pylori in dyspepsia

The main conclusion to be drawn from the study reported by Delaney et al is that no benefit at 12 month follow-up of dyspeptic patients is to be derived from eradication of Helicobacter pylori combined with a four week course of a proton pump inhibitor compared with a four week course of proton pump inhibitor alone.¹

The message to be taken from this is surely that cases of persistent dyspepsia need investigation. Almost certainly, several of these patients would have duodenal ulcers. With this in mind, it would be very interesting to know what the findings were in the group of 99 patients who had eradication treatment for H pylori, and particularly the 57 patients in whom the eradication was confirmed, as almost certainly some of these would have duodenal ulceration and should have benefited from the eradication therapy. This information is not available.

Another message is that this study suggests that H pylori infection is not a causal factor in “dyspepsia.” In a different context, this is consistent with the view that H pylori is not a causal factor in duodenal ulceration but is a secondary infection, causing delay in healing and chronicity. Eradication of the infection leads to healing.^{2 3}