The dyspepsia dilemma

Patients with moderate pain or discomfort in the upper abdomen (dyspepsia) who do not present with warning signs of more serious disease (age less than 50 or signs of blood loss) may have H. pylori infection. This study shows that the eradication of H. pylori does not convey a health benefit. The implication is that patients presenting with moderate upper abdominal discomfort but without warning signs do not require testing for H. pylori infection and should be managed with conventional therapy. A recent meta-analysis supports this recommendation.[Symbol Not Transcribed] A randomized controlled trial involving 170 patients with nonucler dyspepsia (confirmed by endoscopy) and H. pylori infection were randomly assigned to receive triple therapy for eradication of the bacterium (omeprazole 20 mg, amoxicillin 1000 mg and clarithromycin 500 mg, twice daily for 14 days); 167 control subjects with the same condition were given identical-appearing placebos. Successful treatment was defined as the absence of symptoms or only mild pain or discomfort. The study was undertaken at multiple centres in the United States.