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Am Fam Physician. 2000;61(6):1871-1875

One of the principal reasons the optimal therapy for non-ulcer dyspepsia remains controversial is uncertainty concerning the role of Helicobacter pylori. If H. pylori were significantly associated with dyspepsia and associated symptoms, eradication of the organism could be expected to lead to clinical improvement. Jaakkimainen and colleagues reviewed the literature concerning the role of H. pylori in dyspepsia and sought evidence that eradication of the organism would lead to improvement in dyspeptic symptoms.

A search of medical databases from 1983 to 1999 identified 84 potential studies. Systematic review and assessment of all articles resulted in only 23 studies of association and five studies of H. pylori eradication that met criteria for inclusion in the meta-analysis. The studies of the association between H. pylori infection and non-ulcer dyspepsia differed in selection of patients and controls, criteria for diagnosis of H. pylori, and definition of non-ulcer dyspepsia. When the results of the 23 studies were pooled, the odds ratio for association was 1.6, indicting a statistically significant association. The five studies of change in dyspeptic symptoms when H. pylori was eradicated all involved patients referred to gastroenterology clinics. The odds ratio for symptomatic improvement was 1.9 for patients in whom the organism was eradicated.

The authors conclude that infection with H. pylori was associated with a small but significant increased risk of non-ulcer dyspepsia and that eradication of this infection was associated with improvement of symptoms. Patients in whom H. pylori was eradicated were almost twice as likely to report an improvement in dyspeptic symptoms compared with patients in whom H. pylori was not eradicated.

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