Symptoms, endoscopic findings and histology predicting symptomatic benefit of Helicobacter pylori eradication

Objective. To analyse factors predicting changes in dyspeptic symptoms after Helicobacter pylori eradication. Material and methods. Of a total of 342 patients referred for upper gastrointestinal endoscopy at 23 centres in various parts of Finland, those tested positive for the rapid urease test were recruited in the study. Clinical and demographic data and data on dyspeptic symptoms (Gastrointestinal Symptoms Rating Scale) were collected via a structured questionnaire before and a year after the eradication therapy. Gastric biopsies were analysed according to the updated Sydney system. Results. A total of 216 H. pylori-positive patients treated successfully with eradication therapy had complete data to be analysed. After the therapy, dyspeptic symptoms decreased by 29-32%. In a univariate analysis, it was found that duodenal ulcer, female gender, gastric antral neutrophilic inflammation, smoking and age from 50 to 59 years enhanced symptom improvement whereas atrophy in the gastric body reduced it. In a multivariate analysis, duodenal ulcer (odds ratio (OR) 3.2, 95% CI 1.3-7.8) and age from 50 to 59 years (OR 2.2; 95% CI 1.2-3.9) and antral neutrophilic inflammation (OR 1.9, 95% CI 1.1-3.3) were better predictors of symptomatic response. Conclusion. The symptomatic benefit from H. pylori eradication therapy was greatest among duodenal ulcer patients.