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

Background-Helicobacter pylori eradication 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 following H pylori eradication therapy. The symptomatic response was compared with post-treatment H pylori status as determined by the C-14 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 pylori with 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.