title: Effect of colloidal bismuth subcitrate on symptoms and gastric histology in non-ulcer dyspepsia. A double blind placebo controlled study. Relation between Helicobacter pylori infection and gastrointestinal symptoms and syndromes Evaluation of therapies in the treatment of Helicobacter pylori associated non-ulcer dyspepsia. Eradication ofHelicobacter pylori and long-term outcome of functional dyspepsia Bismuth subsalicylate suppression ofHelicobacter pylori in nonulcer dyspepsia: A double-blind placebo-controlled trial Helicobacter pylori Infection and the Risk for Duodenal and Gastric Ulceration Campylobacter pylori--a role in non-ulcer dyspepsia? Long-term outcome of triple therapy in Helicobacter pylori-related nonulcer dyspepsia: a prospective controlled assessment. Double-blind randomized trial of bismuth subsalicylate and clindamycin for treatment of Helicobacter pylori infection. Campylobacter pyloridis and associated gastritis: investigator blind, placebo controlled trial of bismuth salicylate and erythromycin ethylsuccinate. Nitrofurans in the treatment of gastritis associated with Campylobacter pylori. The Gastrointestinal Physiology Working Group of Cayetano Heredia and The Johns Hopkins Universities. Distinct profiles of gastritis in dyspepsia subgroups. Their different clinical responses to gastritis healing after Helicobacter pylori eradication. Campylobacter pylori in Japan: Bacteriological feature and prevalence in healthy subjects and patients with gastroduodenal disorders Dyspepsia, Helicobacter pylori, and peptic ulcer in a randomly selected population in India. Helicobacter pylori seropositivity among Swedish adults with and without abdominal symptoms. A population-based epidemiologic study. Campylobacter pylori and non-ulcer dyspepsia. Helicobacter pylori infection and non-ulcer dyspepsia: the effect of treatment with colloidal bismuth subcitrate. Eradication of Helicobacter pylori affects symptoms in non-ulcer dyspepsia. Are routine duodenal and antral biopsies useful in the management of "functional" dyspepsia? A diagnostic and therapeutic study. Effect of Helicobacter pylori eradication therapy on dyspeptic symptoms in primary care. Accuracy of invasive and noninvasive tests to diagnose Helicobacter pylori infection. Campylobacter pylori-associated gastritis: a double-blind placebo-controlled trial with amoxycillin. Helicobacter pylori gastritis and non-ulcer dyspepsia in childhood. Efficacy of one-week triple antimicrobial therapy in eradicating the organism. Lack of effect of treating Helicobacter pylori infection in patients with nonulcer dyspepsia. Omeprazole plus Clarithromycin and Amoxicillin Effect One Year after Treatment (OCAY) Study Group. Symptomatic benefit from eradicating Helicobacter pylori infection in patients with nonulcer dyspepsia. A placebo controlled trial of bismuth salicylate in Helicobacter pylori associated gastritis. Non-ulcer dyspepsia and short term De-Nol therapy: a placebo controlled trial with particular reference to the role of Campylobacter pylori. Double blind trial of colloidal bismuth subcitrate versus placebo in Helicobacter pylori positive patients with non-ulcer dyspepsia. Absence of benefit of eradicating Helicobacter pylori in patients with nonulcer dyspepsia. Clarithromycin or amoxycillin plus high‐dose ranitidine in the treatment of Helicobacter pylori‐positive functional dyspepsia
abstract: The aim of this study was to determine the effect of colloidal bismuth subcitrate ( De Nol ) on symptoms and gastric histology in patients with non-ulcer dyspepsia . In a single centre trial , patients with food related upper abdominal pain not caused by ulcer disease were r and omised to receive one tablet of colloidal bismuth subcitrate or matching placebo four times daily for eight weeks . Seventy three patients were entered and 51 completed the trial : 28 patients in the colloidal bismuth subcitrate group and 23 in the placebo group . Overall there was no difference between the two groups in terms of symptom relief . Among patients with histological gastritis ( n = 23 ) , however , those who took colloidal bismuth subcitrate used fewer antacid tablets ( for three of four fortnightly periods ) and were more likely to become asymptomatic ( eight of 11 v three of 12 , p less than 0.05 ) ; their gastritis was more likely to resolve ( five of 10 v 0 of 12 , p less than 0.025 ) and their gastric biopsies more likely to become negative for Helicobacter like organisms ( eight of nine v 0 of 12 , p less than 0.001 ) when compared with patients taking placebo . In contrast , patients who did not have gastritis in their index biopsies ( n = 28 ) fared similarly whether they received colloidal bismuth subcitrate or placebo . Our results indicate that the administration of colloidal bismuth subcitrate benefited non-ulcer dyspepsia patients with gastritis but had no effect on those without Background —Helicobacter pylori is a human pathogen that colonises the gastric mucosa and causes permanent gastric inflammation . Aims —To assess the symptoms of H pylori infection in an adult unselected population . Subjects — A r and om sample of 3589 adult Danes who were examined in 1982 and 1987 ( n=2987 ) . Methods —Abdominal symptoms within the preceding year were recorded at both attendances . Circulating IgG antibodies against H pylori in serum sample s drawn in 1982 were measured by using in-house indirect enzyme linked immunosorbent assays ( ELISA ) . Results —People with increased levels of IgG antibodies to H pylori were more likely than uninfected individuals to report heartburn ( odds ratio ( OR ) = 1.26 , 95 % confidence interval ( CI ) 1.03–1.54 ) and abdominal pain characterised by daily length ( OR = 1.33 , 95 % CI 0.92–1.91 ) , nocturnal occurrence ( OR = 1.62 , 95 % CI 1.19–2.19 ) , spring aggravation ( OR = 1.68 , 95 % CI 0.70–4.05 ) , and no relation to meals ( OR = 0.62 , 95 % CI 0.43–0.91 ) or stress ( OR = 0.69 , 95 % CI 0.50–0.95 ) . The inclusion of people with increased levels of IgG antibodies to H pylori , but without upper dyspepsia , at study entry significantly increased the likelihood of reporting upper dyspepsia at follow up ( OR = 1.71 , 95 % CI 1.24–2.36 ) . People with epigastric pain and increased levels of IgM antibodies to H pylori only indicative of acute H pylori infection were more likely to report nocturnal pain , heartburn , nausea , and vomiting . Conclusions —H pylori infection may precede the development of dyspepsia and is associated with a variety of gastrointestinal symptoms in people with no history of peptic ulcer disease This r and omised double blind placebo controlled study evaluated the effectiveness of colloidal bismuth subcitrate ( CBS ) , ampicillin and their combination in the treatment of Helicobacter Pylori in non-ulcer dyspepsia ( NUD ) and assessed if elimination of this organism is associated with improvement of gastritis and the symptoms .  Forty-eight NUD patients with H. pylori and histologic gastritis were r and omly allocated to one of the three regimens for 28 days . Symptoms were assessed before and after treatment . Forty-three patients completed the trial . Repeat endoscopy within 48 hours of completing treatment showed suppression of H. pylori in 6 of 7 patients ( 85.7 % ) on combined therapy and one of 8 patients ( 12.5 % ) on CBS therapy ( p = 0.0205 ) . There was no suppression of the bacteria in patients treated with ampicillin . Repeat endoscopy performed 2 weeks after completing treatment showed suppression of H. pylori in 3 of 7 patients ( 42.9 % ) on combined therapy and none in the other two groups . Patients on combined therapy who had suppression of H. pylori , 48 hours or 2 weeks after completing treatment were noted to have historical improvement of their gastritis ( p = 0.0001 and p = 0.05 respectively ) . This was also associated with improvement of symptoms in these patients The aim of this study was to assess the effect of colloidal bismuth subcitrate ( CBS ) and metronidazole on Helicobacter pylori eradication and on the course of symptoms due to functional dyspepsia . Forty-one patients with functional dyspepsia were entered into the study and r and omized to treatment with CBS ( 120 mg four times a day ) for four weeks combined with metronidazole ( 250 mg four times a day ) for one week ( group A , N=21 ) or matching placebo ( group B , N=20 ) . The severity of gastritis and of bacterial colonization and the symptom score was assessed by endoscopy and clinical evaluation at baseline and after four , eight , and 24 weeks from the start of the treatment . With intent-to-treat analysis eradication was achieved in 16/25 ( 64 % ) patients in group A and in 6/24 ( 25 % ) in group B. At eight and 24 weeks the gastritis score was significantly lower only in those patients with eradication . No change was seen in patients in whom the bacteria was not eradicated . The symptom score at eight weeks was considerably lower both in patients with eradication and in those with infection . However , at 24 weeks a gradual decrease in the symptom score in patients with eradication and a worsening of symptoms in controls was observed . No differences were observed between patients with ulcerlike and those with dysmotility-like dyspepsia .  The study confirms the need for a long observation period after antibacterial treatment in patients with functional dyspepsia and suggests thatHelicobacter pylori-eradicating treatment improves the course of this functional syndrome Gastritis caused byHelicobacter pylori ( HP ) is common in patients with nonulcer dyspepsia ( NUD ) , but an etiologic relationship between the histologic lesion and clinical symptoms is unproven . HP is inhibited by bismuth subsalicylate ( BSS ) , a traditional remedy for dyspeptic complaints . The aim of this study was to assess the short- and long-term effects of BSS on HP , gastritis , and symptoms in patients with NUD . One hundred twenty-six patients with NUD who were shown to be infected withH. pylori ( HP+ ) were enrolled . There was a two-week placebo run-in period to eliminate placebo responders . Fifty patients remained symptomatic and were r and omly assigned to therapy with either BSS liquid or a matching placebo .  EGD , biopsy , and clinical evaluations were performed at entry , at week 5 ( end of therapy ) , at week 9 ( four weeks after therapy ) , or at time of symptomatic relapse . Twenty-seven patients received placebo and 23 patients received BSS . BSS  suppressedH. pylori in 15/23 patients ( 65 % ) and eradicated it in one patient , whereas the placebo had no effect onH. pylori . Gastritis improved during therapy with BSS but relapsed by week 9 . There was no significant change in level of dyspeptic symptoms during or after treatment , although one month after the end of treatment , the patients in the BSS group consistently had lower symptom scores and fewer symptomatic days for all symptoms measured . The study confirms that BSS given for three weeks suppresses but does not usually eradicateH. pylori . Such short-term suppression ofH. pylori heals gastritis but does not result in clinical improvement Infection with Helicobacter pylori probably increases the risk for developing duodenal and gastric ulcer disease . Previous studies have shown that 75 % to 100 % of patients with duodenal ulcer and 35 % to 86 % of patients with gastric ulcer have evidence of an H. pylori infection [ 1 ] . The finding that eradication of H. pylori in patients with duodenal ulcer is associated with a statistically significant decrease in the recurrence rate of the disease further supports the association [ 2 - 5 ] . However , these observations may just reflect the frequent coexistence of duodenal ulcer with antral gastritis [ 6 ] , which has been shown to be caused by H. pylori [ 7 , 8 ] . Wormsley [ 9 ] has noted that the Henle-Koch postulates have not been satisfied for causation of duodenal ulcer by H. pylori because the organism has not been shown to produce the disease . The evidence is weaker that H. pylori causes gastric ulcer because only a single study with 26 patients has shown that antimicrobial therapy directed against H. pylori decreased the gastric ulcer recurrence rate [ 5 ] . None of the previous studies evaluated patients with duodenal or gastric ulcers before they were diagnosed or hospitalized with their disease . The usual temporal sequence is that patients with peptic ulcer disease are examined to detect H. pylori infection at the time the diagnosis is made or after they have had treatment to eradicate the organism . Consequently , peptic ulceration could possibly predispose persons to colonization by H. pylori [ 9 ] . We did a prospect i ve study in a large population -based cohort using serum specimens that were obtained from study participants before they were diagnosed with peptic ulcer . We tried to determine whether H. pylori infection , as shown by the presence of specific IgG antibodies , is a risk factor for the subsequent development of either duodenal or gastric ulceration . Methods Study Population Japanese-American men born from 1900 to 1919 , who were identified by the Honolulu Heart Program in 1965 by using the comprehensive 1942 Selective Service draft registration files [ 10 ] , composed the study population . Of 11 148 eligible men , 8006 ( 72 % ) were interviewed and examined from 1965 to 1968 , 180 ( 2 % ) died before they could be examined , and 2962 ( 26 % ) did not participate in the program . Study participants ranged in age from 45 to 68 years . The data collected included birthplace , marital status , history of alcohol use , blood pressure , and body mass index ( the weight in kilograms divided by the square of the height in meters ) . Serum cholesterol values were determined by the Auto Analyzer N-24A method , and serum glucose values were determined by the Auto Analyzer N-2B method 1 hour after a 50-g glucose load had been given [ 11 ] . A total of 7498 ( 94 % ) men returned for a second examination between 1967 and 1970 , and a serum specimen was obtained at this time . Serum specimens for a 20 % r and om sample of the men were sent to the U.S. Public Health Service Hospital in San Francisco , whereas specimens for the remaining 5924 men were stored at 20C at the study site . Four hundred eighty-one patients with previous gastrectomy or a previous diagnosis of peptic ulcer disease were excluded from the study . The average age of the remaining 5443 patients at the time of their second examination was 56.6 years . Surveillance Methods Surveillance of the cohort to identify incident patients with peptic ulcer was done by a continuous review of discharge records of all general hospitals on Oahu . Based on a 19-year follow-up survey of the study patients from the time of their examination in 1965 to 1968 , only 1.3 % of the men could not be located on Oahu . Thus , surveillance was nearly complete . Two hundred fifty-eight patients were hospitalized with peptic ulcer disease from 1968 to 1989 . One hundred sixty ( 62 % ) patients had their diagnosis confirmed by examination of tissue obtained by either surgery or biopsy , 36 ( 14 % ) were diagnosed by radiologic examination , and 62 ( 24 % ) were clinical ly diagnosed based on the endoscopic or surgical report of the presence of an ulcer . One hundred sixty-nine incident patients had gastric ulcer , 73 had duodenal ulcer , and 16 had gastric and duodenal ulcers . Seventeen of the 169 patients with gastric ulcer , 6 of the 73 patients with duodenal ulcer , and 2 of the 16 patients with gastric and duodenal ulcers were removed from study because they had an insufficient amount of serum in the freezer repository . Selection of Controls Each of the remaining patients was matched with one control from the study cohort based on age at examination ( 47 to 70 years ) and date of serum collection . If a potential control had a diagnosis of gastric cancer before or after the serum was obtained , he was excluded from the study . As a consequence , 160 patients ( 3.1 % ) were removed from the control pool of 5185 men because of the reported association between H. pylori infection and gastric cancer [ 12 , 13 ] . Of the remaining 5025 men , 336 ( 6.7 % ) were excluded because they previously had cardiovascular disease or other cancer , and 1532 ( 30.5 % ) were excluded because they were diagnosed with cardiovascular disease or other cancer after their serum collection . This exclusion was done because the serum specimens from these patients are going to be used for other studies . A total of 3157 patients remained in the pool of controls from which 233 ( 7.4 % ) were matched to incident case- patients with peptic ulcer . Each control participant was alive at the time of hospitalization of the matched case-patient , so that death was not a competing factor . Serologic Testing The presence of serum IgG antibodies to H. pylori was determined by enzyme-linked immunosorbent assay ( ELISA ) , using the Pyloristat kit ( Whittaker Bioproducts , Inc. , Walkersville , Maryl and ) . As vali date d by the manufacturer , the results of this assay closely mirror those of a previously described IgG ELISA [ 13 - 18 ] . In brief , serum specimens from patients were diluted 1:20 for use in the kit , and IgG levels of sera were determined according to the manufacturer 's instructions . The serum specimens were coded so that the laboratory technician could not distinguish case- patients from controls . A ratio of 1.00 or greater was considered positive , a ratio of less than 0.80 was considered negative , and a ratio of 0.80 to 0.99 was considered equivocal , as calibrated in the kit . Two patients with gastric ulcer and two patients with duodenal ulcer or their controls had equivocal values , so they were excluded from the study . Statistical Analysis A matched casecontrol study design was used to identify the patients and controls for serum tests . As a result , odds ratios , based on the results of the H. pylori IgG antibody test , were determined using conditional logistic regression methods [ 19 ] . When odds ratios were indeterminable , approximate confidence intervals ( CIs ) were determined by the method of Breslow and Day [ 19 ] . Tests for trend in the logit of risk were derived from conditional logistic regression models by using grouped H. pylori test results ( coded as 1 , 2 , 3 , and 4 ) . All conditional logistic regression models were fitted using iterative maximum likelihood methods and a special application of the proportional hazards regression model [ 20 ] . Results The characteristics of the 229 patients with peptic ulcer and of their matched controls are presented in Table 1 . The two groups of men were similar with respect to demographic characteristics and laboratory values . Table 1 . Characteristics of Patients with Peptic Ulcer and of Controls The mean age at diagnosis was 67.5 years ( range , 52.7 to 87.2 years ) for the 150 patients with gastric ulcer , 64.5 years ( 49.4 to 80.0 years ) for the 65 patients with duodenal ulcer , and 63.5 years ( 52.4 to 83.1 years ) for the 14 patients with gastric and duodenal ulcers . Table 2 shows the association between the H. pylori test result and peptic ulcer by specific type . Ninety-three percent ( 139 of 150 ) of the patients with gastric ulcer and 78 % ( 117 of 150 ) of the matched controls had a positive H. pylori-specific IgG antibody level , yielding an odds ratio of 3.2 ( P = 0.001 ) . ( The odds ratio is determined by dividing 32 pairs by 10 -/+ pairs . ) Ninety-two percent of the case- patients with duodenal ulcer and 78 % of the matched controls had a positive test result , yielding an odds ratio of 4.0 ( P = 0.03 ) . If a patient had either a gastric or duodenal ulcer , then the odds ratio was 3.4 ( P = 0.0001 ) . Only 14 patients had both gastric and duodenal ulcers . The odds ratio was 1.3 ( P > 0.2 ) , based on these patients . Table 2 . Odds Ratio for the Association between Helicobacter pylori Seropositivity and Type of Peptic Ulcer Because some of the hospitalized patients with peptic ulcer may have developed their ulcers after the use of adrenocorticosteroids or nonsteroidal anti-inflammatory drugs , we systematic ally review ed the hospital records of the patients . A similar review could not be done for the controls because they were not hospitalized . We found that 18 of the 150 patients with gastric ulcer and 9 of the 65 patients with duodenal ulcer had taken these medications at the time of hospitalization . If these patients and their matched controls were excluded , the odds ratio would have been 3.3 ( 95 % CI , 1.6 to 7.0 ) for gastric ulcer , 3.3 ( CI , 0.9 to 12.1 ) for duodenal ulcer , and 3.3 ( CI , 1.7 to 6.4 ) for either gastric or duodenal ulcer . Of the 215 patients with either gastric or duodenal ulcer , 100 also had a hospital-based diagnosis of cardiovascular disease or cancer .  If these patients were excluded from the study , as were controls with these diseases , 115 patients with gastric or duodenal ulcer would have remained in the study . Ninety-four percent of these case- patients and 77 % of their controls had a positive test result for H. pylori antibody . The odds ratio for peptic ulcer was 4.3 ( CI , 1.8 to 10.5 ) in this group of patients . When the patients with gastric ulcer who had positive antibody Non-ulcer dyspepsia ( NUD ) is a common complaint in which no systematic illness or organic proximal alimentary tract disease can be identified . The pathophysiology of NUD is probably heterogeneous . Eighty-two subjects with NUD were studied in a prospect i ve r and omized placebo-controlled study to assess the efficacy of colloidal bismuth subcitrate ( CBS ) chewable tablets at a dose of four tablets daily for 1 month . The role of Campylobacter pylori and associated histological gastritis was evaluated . Sixty-one percent of NUD patients had C. pylori in the gastric antrum compared with 25 % of age-matched controls . C. pylori was associated with acute and chronic inflammation ( P less than 0.001 ) in the antrum . C. pylori was cleared in 59 % of CBS-treated subjects compared with only 4 % placebo ( P less than 0.05 ) . Both acute and chronic inflammation improved in subjects cleared of bacteria . Clearance of C. pylori and histological improvement was associated with a significant decrease in symptoms . In C. pylori negative subjects improvement in symptoms occurred in both the placebo and active treatment groups . This study would suggest that C. pylori and associated histological gastritis may play a role in non-ulcer dyspepsia OBJECTIVE To ascertain whether triple therapy alters the history of Helicobacter pylori (HP)-related nonulcer dyspepsia ( NUD ) . METHODS Forty-one young ( < 45 yr ) dyspeptic patients were confirmed to be HP-related NUD by serology , rapid urease test , and antral biopsy . Endoscopy excluded the presence of ulcer . These cases were r and omly plotted into control ( n = 21 ) and triple therapy ( n = 20 ) groups . In the former group , H2 blocker was given for 2 months and then intermittent antisecretory agents for up to 1 yr . In the latter group , 20 patients received a course of triple therapy and then were treated like the control group . The symptom scores ( range : 0 - 10 ) were collected on enrollment , and at the end of 2nd , 6th , and 12th months . Each case had serial tests of HP IgG ELISA titer on start , at weeks 2 , 4 , and 8 , at the 6th month , and at the end of the 1st yr . The second endoscopy was done in the 9th wk for eradication survey , and the third endoscopy , at the end of the 1st yr to resurvey the HP status . The histological gradings of biopsy specimens , sample d on each endoscopy , were compared . RESULTS In the triple therapy group , the rate of eradication of HP was 75 % . At he end of the 2nd month , the HP-eradicated cases of the triple therapy group improved the symptom score more significantly then the noneradicated cases ( 2.42+/-1.37 vs.4.76+/-1.58 , p < 0.001 ) . At the ends of the 6th month and 1st yr , the symptom scores of the eradicated cases improved more significantly than those of the control group ( 6th month , 0.61+/-1.18 vs. ] 2.66+/-2.06 ; 1st yr , 0.82+/-1.17 vs. ] 3.56+/-2.89 , p < 0.001 ) . The decline trend of ELISA titers occurred only in eradicated cases and became significantly evident from the 4th wk ( 0.30+/-0.15 vs. ] 0.49+/-0.07 , p < 0.05 ) and thereafter . Both acute and chronic pathological grading was improved in the triple group at the end of the 1st yr ( acute , 1.95 - 0.46 ; chronic , 1.9 - 0.92 ; p < 0,01 ) CONCLUSION Compared with control therapy at 1 yr , triple therapy showed greater symptomatic , serological , and histological improvements . Therefore , triple therapy is beneficial to symptomatic HP-related NUD We evaluated clindamycin and bismuth subsalicylate ( Pepto-Bismol ) for treatment of Helicobacter pylori infection . Patients with culture or histology positive for H. pylori were r and omized to receive two tablets of bismuth subsalicylate four times daily for 4 weeks or bismuth combined with 2 weeks of 300 mg clindamycin four times daily . Clinical symptoms were recorded before and after treatment by means of visual analog scales . Patients in both treatment arms showed improvement in clinical scores for abdominal pain , heartburn , and gas or bloating . Microbiologic cure was achieved in only 1 of 11 patients treated with bismuth alone and in none of 7 treated with bismuth/clindamycin .  Successful eradication of H. pylori may require combination of multiple antibiotics , as recommended at the IXth World Congress of Gastroenterology , or pharmacokinetic modulators such as H2-blockers or omeprazole An investigator blind trial was performed comparing bismuth salicylate , erythromycin ethylsuccinate , and placebo in the treatment of Campylobacter pyloridis associated gastritis in patients without peptic ulceration . Fifty patients fulfilled the study criteria . There was a strong correlation between the presence of C pyloridis and histologically confirmed gastritis . Clearance of organisms led to improvement of the gastritis . C pyloridis was cleared from 15 patients ; of these , 13 had gastritis initially , which resolved in 12 . Conversely , gastritis resolved in only four of 32 patients not cleared of organisms ( p less than 0.0001 ) . There was significantly greater improvement in endoscopic appearances in the patients cleared of C pyloridis compared with those whose infection persisted ( p less than 0.001 ) . In the three treatment groups organisms were cleared from 14 of 18 patients receiving the locally active bismuth salicylate , only one of 15 patients receiving erythromycin ethylsuccinate , and none of 17 patients taking placebo . These findings suggest that the ideal antimicrobial for the successful eradication of C pyloridis associated gastritis should be locally active , stable at low pH , and should penetrate gastric mucus . The resolution of gastritis and improvement in endoscopic appearances associated with clearance of C pyloridis support the view that these organisms may play a part in this condition We conducted a double-blind , placebo-controlled , r and omized treatment study in Peruvian adults with antral gastritis associated with Campylobacter pylori . Patients received either 400 mg of furazolidone ( n = 14 ) , 400 mg of nitrofurantoin ( n = 24 ) , or a placebo ( n = 31 ) for 14 days . Endoscopy was carried out at baseline , 1 day after ceasing therapy , and 6 wk after the end of treatment to verify colonization by C. pylori and determine the extent of gastric inflammation . Treatment with nitrofurantoin or furazolidone markedly reduced or , in some cases , cleared C. pylori from the antrum ( p less than 0.0005 compared with placebo ) . Resolution of acute gastric inflammation , as evidence d by decreased polymorphonuclear leukocyte infiltration and regeneration of the mucus layer , paralleled the reduction in bacterial colonization ( p less than 0.005 compared with placebo ) . A high percentage of patients experienced relapse ( recolonization by C. pylori and return to pretreatment levels of gastritis ) within 6 wk after cessation of treatment . Significant relief of dyspeptic symptoms was not evident during the study BACKGROUND A contribution of Helicobacter pylori gastritis to the pathogenesis of non-ulcer dyspepsia ( NUD ) remains uncertain . METHODS Administration of an appropriate clinical question naire followed by endoscopy allowed us to select , among 139 out patients with dyspepsia , 87 non-ulcer dyspepsia patients with more severe and group-distinctive symptoms , 35 of whom were classified as having ulcer-like ( ULD ) . 38 as dysmotility-like ( DLD ) , and 14 as reflux-like dyspepsia ( RLD ) . Biopsy specimens were evaluated for H. pylori gastritis in accordance with the Sydney system . The 70 H. pylori-positive cases were treated with omeprazole , 20 mg twice daily , and amoxycillin , 1 g three times daily for 2 weeks . RESULTS Higher rates of H. pylori colonization were found histologically in the gastric mucosa of ULD ( 91 % ) and RLD ( 86 % ) than in that of DLD ( 68 % ) or asymptomatic ( 42 % ) patients . ULD differed from RLD patients in their higher score of antritis activity . Three and 6 months after H. pylori eradication ULD ( but not DLD ) showed significant regression of dypspetic symptoms scores . CONCLUSIONS It seems likely that H. pylori gastritis , with special reference to active antritis , is among causative factors of ULD . Its role in the pathogenesis of RLD and DLD needs further investigation Summary The presence ofCampylobacter pylori was investigated in biopsy specimens obtained during  gastrofiberscopy  from 103 consecutive patients prospect ively . Patients included 25 with gastric ulcer , 4 with duodenal ulcer , 5 with coexisting gastroduodenal ulcer , 31 with gastroduodenal ulcer with gastritis , 27 with gastritis , 3 with gastric polyps and 8 with gastric cancer . Results were compared with 20 healthy control subjects who were endoscopically normal . Two specimens each were taken from 3 sites in the stomach . One part was used for a histological study to examine the presence of the organisms . The other part was cultured using Skirrow ’s agar microaerophilically .  Conventional microflora and C. pylori were examined in gastric contents of some cases . Bacteriological features of isolated strains of C.pylori were identical to the NCTC strain . C.pylori was the most dominant organism in gastric contents at any pH level . Detection rates of C.pylori by bacteriological culture were 96 % in gastric ulcer , 100 % in duodenal ulcer , 80 % in coexisting gastroduodenal ulcer , 84 % in gastroduodenal ulcer with gastritis , 70 % in gastritis , 100 % in gastric polyps and 100 % in gastric cancer , and the percentages recognized by histological studies were 81,100,100 , 84 , 71 , 67 , and 57 % , respectively . The values in healthy controls were 55 % by histological and bacteriological methods ( P<0.001 compared with overall ulcer patients ) . These results supported the close association between C.pylori and gastroduodenal diseases There seems to be a worldwide geographic variation in the prevalence of peptic ulcer disease , although there are few reliable population based studies . This study aim ed to determine the prevalence of peptic ulcer disease in a community in southern India and to evaluate the relationship between dyspeptic symptoms , Helicobacter pylori infection , gastritis , and peptic ulcer disease . A sample population was selected r and omly from a rural monastic settlement in southern India . Subjects were interviewed using a st and ardised symptom and demography question naire then underwent upper endoscopy and antral biopsy for histology and CLO rapid urease test .  Altogether 197 subjects from a population of 1499 ( 13.1 % ) were studied . All were male monks and ethnically Tibetan . The median age was 28 years ( range : 21 - 81 ) . None smoked or took NSAIDs . The six month period prevalence of dyspeptic symptoms was 68.5 % . Current symptoms were present in 58.9 % of subjects . Dyspepsia was more common in subjects aged 40 years or younger ( p < 0.0001 ) . H pylori was detected in 77.2 % subjects . There was no association between dyspepsia and the presence of H pylori or histological gastritis , although there was a strong correlation between symptoms and ulcer ( p < 0.003 ) . The point prevalence of active peptic ulcer was 6.6 % ( 13/197 ) . All ulcers detected were either prepyloric or pyloroduodenal in location . A further 6.6 % of subjects had definite evidence of scarring or deformity indicative of ulceration in the past . Subjects with past or present ulcers comprised 17.8 % of dyspeptic subjects . H pylori was present in all subjects with active ulcers and in 12/13 of those with scarring . Dyspepsia , H pylori infection , gastritis , and peptic ulcer are all more common in this population than in those from developed countries . Ulcer disease , however , accounts for only a small proportion of subjects with symptoms and neither H pylori infection nor gastritis are significantly associated with the presence of dyspepsia BACKGROUND The role of Helicobacter pylori in functional dyspepsia is unclear . The aim of this population -based study was to determine whether the prevalence of H. pylori infection is higher among people with dyspepsia or irritable bowel syndrome ( IBS ) than among symptomless persons after control for age , sex , and socioeconomic status . METHODS In a postal question naire we asked a representative sample ( 20 - 79 years ; n = 1260 ) from a Swedish municipality about abdominal symptoms in the preceding 3 months . A r and omly selected sub sample , 50 with dyspepsia , 50 with IBS , and 50 symptomless , matched with regard to age , sex , and education , were tested for the presence of IgG antibodies to H. pylori , using the HM-CAP immunoassay . RESULTS Fifty-five persons ( 38 % ) were H. pylori-seropositive . The seroprevalence among dyspeptics ( 33 % ) did not exceed that in healthy people ( 48 % ) or in those reporting IBS ( 33 % ) . The prevalence increased with age and with lower social class , but the latter association disappeared when age was taken into account . Neither sex nor symptom intensity predicted Helicobacter seropositivity . CONCLUSION Our data are incompatible with an important aetiologic role for H. pylori in functional dyspepsia Non-ulcer dyspepsia ( NUD ) is a poorly understood syndrome often present in association with gastritis . Among patients undergoing gastroscopy  , some with NUD have a gastric mucosa colonized by the campylobacter-like organism , Campylobacter pylori . We therefore studied prospect ively 55 consecutive patients with NUD and 15 normal controls to determine the prevalence of C. pylori organisms , and to investigate their association with histological gastritis , macroscopic evidence of gastritis , sex , smoking , alcohol consumption , and dyspeptic symptoms . We found a 45.4 % prevalence in NUD patients which was statistically significantly higher than the 13.33 % prevalence in the control group ( p less than 0.05 ) . We also found a close association between C. pylori and microscopic evidence of gastritis ( p less than 0.001 ) , male sex ( p less than 0.001 ) , and postpr and ial bloating ( p less than 0.05 ) . We did not find any significant association between C. pylori and macroscopic evidence of gastritis , smoking , alcohol consumption and other dyspeptic symptoms . Our findings suggest that C. pylori may play a pathogenic role in NUD A study was undertaken to determine the role of Helicobacter pylori in non-ulcer dyspepsia ( NUD ) and to determine the efficacy of colloidal bismuth subcitrate ( CBS ) in the treatment of NUD . Seventy-one patients were r and omly allocated ( double blind ) to CBS or placebo , two tablets twice daily for 4 weeks . The severity of dyspepsia was scored and endoscopies performed before and after treatment , and antral biopsy specimens were taken for bacteriologic and histologic examination . Forty patients had H. pylori infection , and all had changes of chronic active gastritis .  H. pylori was cleared from 17 to 21 patients ( 81 % ) treated with CBS , whereas none of the 19 patients treated with placebo cleared the bacteria . Improvement in histology was noted in 15 of 21 patients ( 71.4 % ) treated with CBS , whereas no improvement was noted in any of the placebo controls . Thirty-one patients were negative for H. pylori . All had either normal gastric histology or minor degrees of inflammation . Seventeen of these patients received CBS , and 14 received placebo . All groups reported improvement in the symptom score ; however , the H. pylori-positive , CBS-treated group recorded a significantly higher improvement than the other groups ( p less than 0.001 ) . Relapse of H. pylori infection after initial clearance of the bacteria was high . Twelve of 16 patients evaluated relapsed 1 month after withdrawal of CBS BACKGROUND The relationship between Helicobacter pylori infection and non-ulcer dyspepsia is controversial . METHODS In a prospect i ve , long-term , double-blind study we r and omized 100 patients with non-ulcer dyspepsia and H. pylori infection to receive either of two treatment regimens : 1 ) bismuth-based triple therapy ( n = 50 ) or 2 ) bismuth + placebo ( n = 50 ) . RESULTS Triple therapy : subjects who became H. pylori-negative ( n = 42 ) showed a significant symptomatic response when interviewed at 8 weeks , 6 months , and 1 year ( P < 0.01 ) . This improvement was evident in the ' ulcer-like ' dyspepsia group at all times ( P < 0.01 ) but in the ' reflux-like ' and ' motility-like ' groups at 6 months only ( P < 0.01 ) . Those who remained H. pylori-positive showed no decrease in symptoms at 8 weeks , 6 months , and 1 year . Bismuth-placebo therapy : subjects who became H. pylori-negative ( n = 7 ) showed an improvement in symptoms at 8 weeks , 6 months , and 1 year . Those who continued to harbour the infection after treatment ( n = 42 ) showed an insignificant improvement in the motility and non-specific groups only . CONCLUSION This study shows that eradication of H. pylori results in a significant long-term reduction in symptoms of non-ulcer dyspepsia Fifty-three patients with previously uninvestigated chronic dyspepsia symptoms in the absence of gastrointestinal or extra-gastrointestinal disease ( functional dyspepsia ) underwent antral and duodenal mucosal biopsies to detect the role of such samplings in the presence of normal endoscopic findings . Patients were enrolled in a r and omized , placebo-controlled , double-blind trial , receiving either eradicating treatment ( colloidal bismuth subcitrate plus metronidazole ) or placebo if they had Helicobacter pylori-associated gastritis ( 20 patients ) , or cisapride or placebo if they had normal antral mucosa ( 28 cases ) . Unsuspected celiac sprue was found in one patient . Eradicating treatment ameliorated histological gastritis ( p = 0.01 ) . However , owing to great placebo efficacy , symptom remission rates following a 1-month wash-out period in both treatment groups were no higher than that in controls . Independent of the initial r and omization , an extremely low symptom recurrence rate was observed during a drug-free follow-up study equivalent to the mean duration of symptoms before enrollment . We conclude that in functional dyspepsia , bulbar and antral biopsies are not useful in clinical management , equivalent symptom relief can be achieved in patients r and omly assigned to both drugs and placebos , and such improvement can be long lasting in the absence of any maintenance treatment . We believe the prevalence of unsuspected villous atrophy and the therapeutic role of investigation-based reassurance deserve further assessment OBJECTIVE The aim was to explore the effect of eradication therapy on dyspeptic symptoms in patients with known peptic ulcer disease ( PUD ) . METHOD A total of 164 known dyspeptics and 147 non-dyspeptic attenders at six UK general practice s were recruited . The Helisal Rapid Blood test was performed in the practice s and eradication therapy left to the preference of the general practitioner . Patients were followed prospect ively by a Likert scaled symptom question naire and record review . The symptom question naire distinguished between patients known to have dyspepsia and those not . RESULTS There was a statistically significant decrease in dyspeptic symptoms in patients with known PUD who received eradication therapy ( n = 43 , Z = -2.63 , P = 0.009 ) . CONCLUSIONS Eradication of Helicobacter pylori in primary care can lead to a reduction in consumption of H2 receptor antagonists and hence cost savings . This study demonstrates that dyspeptic symptoms also decrease . The question naire could be used in further studies to evaluate the effect of management on dyspeptic symptoms in the primary care setting BACKGROUND & AIMS Multiple tests are available for determining Helicobacter pylori infection . Our aim was to compare the sensitivity , specificity , and negative and positive predictive value of the most widely available tests for diagnosis of H. pylori . METHODS A total of 268 patients ( mean age , 53.7 + /- 15.8 years ; 142 male and 126 female ; 125 white and 143 nonwhite ) was tested for H. pylori infection by [13C]urea breath test ( UBT ) , measurement of serum immunoglobulin ( Ig ) G and IgA antibody levels , and antral biopsy specimens for CLO test , histology , and Warthin-Starry stain . No patient received specific treatment for H. pylori before testing . The infection status for each patient was established by a concordance of test results . RESULTS Warthin-Starry staining had the best sensitivity and specificity , although CLO test , UBT , and IgG levels were not statistically different in determining the correct diagnosis . The absence of chronic antral inflammation was the best method to exclude infection . Stratification of results by clinical characteristics showed that UBT and chronic inflammation were the best predictors of H. pylori status in patients older than 60 years of age . IgA was a better predictor in white patients . CONCLUSIONS The noninvasive UBT and IgG serology test are as accurate in predicting H. pylori status in untreated patients as the invasive tests of CLO and Warthin-Starry We r and omly assigned 45 adult patients with Campylobacter pylori-confirmed antral gastritis to 8 days of treatment with 1 g amoxycillin suspension twice a day , or placebo , according to a double-blind study design . At the end of therapy , 91 % of patients treated with amoxycillin demonstrated clearance of the organism from the antrum , compared with 16 % in the placebo group ( p less than 0.001 ) . Active antral gastritis resolved in 68 % of patients in the amoxycillin group versus only 9 % in the placebo group ( p less than 0.001 ) . No significant difference was observed when looking at the evolution of chronic only gastritis . No significant improvement was observed in the assessment of clinical symptoms and endoscopic appearance . Reappearance of C. pylori and significant worsening of the histological score of active gastritis was observed after 2 wk in all patients . In a second study phase , 18 patients initially not cleared of their bacteria received amoxycillin single blind for 14 days . Clearance of bacteria associated with improvement or resolution of active gastritis was observed in 72 % of the cases . In this subgroup , all patients investigated after 1 month were recolonized with C. pylori and , again , had histological active gastritis . We conclude that amoxycillin is effective in treating active antral gastritis associated with C. pylori , but not in preventing relapses , which occur in all cases within 1 month after therapy Efficacy of one-week triple antimicrobial therapy ( bismuth , tinidazole , amoxicillin ) as compared to the same drug combination given for 4 weeks was assessed in children with Helicobacter pylori ( H. pylori ) gastritis and non-ulcer dyspepsia . Twenty-six patients ( group A ) and 30 ( group B ) had one-week and four-week schedule , respectively . Eradication ( absence of organism at endoscopy at least 1 month after ending treatment ) was achieved in 84.6 % of group A ( 22 ) and 83.3 % of group B ( 25 ) , with marked reduction of histological gastritis score in both groups . Among patients with eradicated H. pylori , symptoms improved significantly in 14 and 16 patients of group A and B , respectively , but were still present in 17 ( 8 group A , 9 group B ) . The latter showed gastroparesis and abnormal gastro-oesophageal reflux at a subsequent diagnostic work-up and improved with prokinetic therapy . In 3 patients of group A and 3 of group B , symptoms improved despite persistence of bacterium into the stomach . Finally , in 3 cases ( 1 group A , 2 group B ) both symptoms and H. pylori infection were unchanged . At 6 month follow-up , symptoms were present in 7 patients ( 3 group A , 4 group B ) : 6 of them ( 3 group A , 3 group B ) showed H. pylori gastritis at endoscopy . We conclude that in children with dyspepsia and H. pylori gastritis one-week triple antimicrobial schedule is effective in eradicating bacterium ; however , detection of H. pylori gastritis in dyspeptic children does not invariably indicate a pathogenic role of the organism in these patients BACKGROUND It is uncertain whether treatment of Helicobacter pylori infection relieves symptoms in patients with nonulcer , or functional , dyspepsia . METHODS We conducted a double-blind , multicenter trial of patients with H. pylori infection and dyspeptic symptoms ( moderate-to-very-severe pain and discomfort centered in the upper abdomen ) . Patients were excluded if they had a history of peptic ulcer disease or gastroesophageal reflux disease and had abnormal findings on upper endoscopy . Patients were r and omly assigned to seven days of treatment with 20 mg of omeprazole twice daily , 1000 mg of amoxicillin twice daily , and 500 mg of clarithromycin twice daily or with omeprazole alone and then followed up for one year . Treatment success was defined as the absence of dyspeptic symptoms or the presence of minimal symptoms on any of the 7 days preceding the 12-month visit . RESULTS Twenty of the 348 patients were excluded after r and omization because they were not infected with H. pylori , were not treated , or had no data available . For the remaining 328 patients ( 164 in each group ) , treatment was successful for 27.4 percent of those assigned to receive omeprazole and antibiotics and 20.7 percent of those assigned to receive omeprazole alone ( P=0.17 ; absolute difference between groups , 6.7 percent ; 95 percent confidence interval , -2.6 to 16.0 ) . After 12 months , gastritis had healed in 75.0 percent of the patients in the group given omeprazole and antibiotics and in 3.0 percent of the patients in the omeprazole group ( P<0.001 ) ; the respective rates of H. pylori eradication were 79 percent and 2 percent . In the group given omeprazole and antibiotics , the rate of treatment success among patients with persistent H. pylori infection was similar to that among patients in whom the infection was eradicated ( 26 percent vs. 31 percent ) . There were no significant differences between the groups in the quality of life after treatment . CONCLUSIONS In patients with nonulcer dyspepsia , the eradication of H. pylori infection is not likely to relieve symptoms BACKGROUND The eradication of Helicobacter pylori infection is beneficial in patients with gastric or duodenal ulcers . The value of eradicating the infection in patients with dyspepsia and no evidence of ulcer disease is not known . METHODS We performed a r and omized , placebo-controlled trial comparing the efficacy of treatment for two weeks with 20 mg of omeprazole orally twice daily , 500 mg of amoxicillin three times daily ( with 500 mg of tetracycline three times daily substituted for amoxicillin in patients allergic to penicillin ) , and 400 mg of metronidazole three times daily ( 160 patients ) with that of omeprazole alone  ( 158 patients ) for resolving symptoms of dyspepsia in patients with H. pylori infection but no evidence of ulcer disease on upper gastrointestinal endoscopy . Symptoms were assessed with the Glasgow Dyspepsia Severity Score , with resolution of symptoms defined as a score of 0 or 1 in the preceding six months ( maximal score , 20 ) . One year later the patients were assessed to determine the frequency of the resolution of symptoms . RESULTS One month after the completion of treatment , 132 of 150 patients ( 88 percent ) in the group assigned to received omeprazole and antibiotics had a negative test for H. pylori , as compared with 7 of 152 ( 5 percent ) in the group assigned to receive omeprazole alone . One year later , dyspepsia had resolved in 33 of 154 patients ( 21 percent ) in the group given omeprazole and antibiotics , as compared with 11 of 154 ( 7 percent ) in the group given omeprazole alone ( 95 percent confidence interval for the difference , 7 to 22 percent ; P<0.001 ) . Among the patients in the group given omeprazole and antibiotics , the symptoms resolved in 26 of the 98 patients ( 27 percent ) who had had symptoms for five years or less , as compared with 7 of the 56 patients ( 12 percent ) who had had symptoms for more than five years ( P=0.03 ) . CONCLUSIONS In patients with H. pylori infection and nonulcer , or functional , dyspepsia , treatment with omeprazole and antibiotics to eradicate the infection is more likely to resolve symptoms than treatment with omeprazole alone In a placebo controlled prospect i ve clinical trial of bismuth salicylate in helicobacter pylori associated gastritis  , 52 adult patients were r and omly allocated to treatment with bismuth salicylate or placebo .  Helicobacter pylori were totally cleared in 77 % patients in bismuth group but none in placebo group ( P less than 0.001 ) . Resolution of gastritis ( P less than 0.001 ) and improvement of symptoms ( P less than 0.01 ) were significantly better in patients where H. pylori infection cleared as compared to patients where the infection persisted This double blind r and omised study tested the effectiveness of colloidal bismuth subcitrate ( De-Nol ) in non-ulcer dyspepsia ( NUD ) and if any benefit is associated with clearance of Campylobacter pylori ( C pylori ) from the gastric mucosa . Sixty six patients with dyspepsic symptoms , normal abdominal ultrasound , and upper GI endoscopy , were r and omly allocated to placebo or De-Nol for eight weeks . Antral biopsies were taken for bacteriological and histological examination , and endoscopies and clinical question naires were administered before and after treatment . Fifty two patients ( 25 on De-Nol and 27 on placebo ) completed the trial .  De-Nol  cleared C pylori from 10 of the 12 C pylori positive patients ( 83.3 % ) , whereas placebo did not clear C pylori from any of the eight C pylori positive patients ( p less than 0.01 ) . In patients receiving De-Nol  gastritis improved ( p less than 0.01 ) and symptomatic response was better ( p less than 0.001 ) compared with placebo . In the placebo group seven of the 19 C pylori negative patients became positive : this was associated with significant deterioration of symptoms , a phenomenon not seen in the De-Nol treated group We have carried out a double blind placebo controlled trial to assess the effects of treatment with colloidal bismuth subcitrate in Helicobacter pylori associated non-ulcer dyspepsia . Eighty patients with dyspepsia , normal upper gastrointestinal appearances at endoscopy and H pylori associated active chronic gastritis on histology of gastric antral biopsies were included in the trial . The patients were r and omised to receive colloidal bismuth subcitrate 240 mg twice daily for four weeks or matching placebo and were reassessed four weeks after completing treatment . Twenty-six patients ( 67 % ) receiving colloidal bismuth subcitrate had normal histology or improved inflammation compared with five ( 13 % ) receiving placebo ( p less than 0.001 ) , and symptoms were absent or improved in 32 ( 82 % ) and two ( 5 % ) respectively ( p less than 0.001 ) . Serum IgG level was a marker of infection , and fell with successful treatment . Colloidal bismuth subcitrate is effective treatment for H pylori associated non-ulcer dyspepsia with improved gastric antral histological appearances and has a beneficial effect on symptoms BACKGROUND The relation between Helicobacter pylori infection and nonulcer dyspepsia is uncertain . We tested the hypothesis that curing the infection will relieve symptoms of dyspepsia . METHODS We r and omly assigned 170 H. pylori-infected patients with nonulcer dyspepsia to receive twice-daily treatment with 20 mg of omeprazole , 1000 mg of amoxicillin , and 500 mg of clarithromycin for 14 days and 167 such patients to receive identical-appearing placebos ; all patients were then followed through regular visits for 12 months . Symptoms were scored on diary cards for seven days before each visit . A carbon-13 urea breath test was performed at base line and repeated at 1 and 12 months , and endoscopic biopsy was performed at 12 months to determine H. pylori status . Treatment was considered successful if the patient had only mild pain or discomfort or none at all . RESULTS The rate of eradication of H. pylori infection was 90 percent in the active-treatment group and 2 percent in the placebo group at four to six weeks ( P<0.001 ) . At 12 months , there was no significant difference between groups in the rate of successful treatment ( 46 percent in the active-treatment group and 50 percent in the placebo group ; relative likelihood of success with active treatment , 0.93 ; 95 percent confidence interval , 0.73 to 1.18 ; P=0.56 ) . There was also no significant difference in the rate of successful treatment at 12 months between patients who were H. pylori-negative and those who were H. pylori-positive ( 48 percent vs. 49 percent ) . The rates of successful treatment were also similar when patients were analyzed according to the type of dyspepsia ( ulcer-like , reflux-like , or dysmotility-like ) and changes in the quality of life . There was no significant association between treatment success and histologic improvement in chronic gastritis at 12 months ( P=0.68 ) . CONCLUSIONS We found no evidence that curing H. pylori infection in patients with nonulcer dyspepsia leads to relief of symptoms Objective This study was intended to investigate the effect of ranitidine in dual anti-Helicobacter pylori therapy . Simultaneously , it was to evaluate the potential effect of H. pylori eradication on the symptomatology of H. pylori-positive dyspepsia . Patients and methods Fifty-four patients with H. pylori infection and symptoms of non-ulcer dyspepsia were r and omly assigned to treatment with either amoxycillin 500 mg four times daily plus ranitidine 300 mg four times daily , clarithromycin 500 mg twice daily plus ranitidine 300 mg twice daily , clarithromycin 500 mg four times daily plus ranitidine 300 mg twice daily or clarithromycin 500 mg four times daily plus ranitidine 300 mg four times daily for a period of 12 days . In addition , ranitidine 150 mg twice daily was given for a further 16 days . Results Eradication of H. pylori using the assigned treatments was achieved in 47 % ( seven out of 15 ) , 50 % ( five out of 10 ) , 70 % ( seven out of 10 ) and 77 % ( 10 out of 13 ) of patients , respectively . Failure of therapy with clarithromycin was associated with primary or acquired resistance after treatment in 91 % ( 10 out of 11 ) . Symptom improvement was significant ( P= 0.0001 ) and similar in all of the four treatment groups up to week 8 . As regards H. pylori status , no differences in the mean symptom score improvement could be found between patients with eradication and those with persistent infection ( 12.3–7.0 , P= 0.0001 , n = 29 compared with 13.0–6.5 , P= 0.004 , n = 19 ) . After 1 year the symptom score had increased both in patients with persistent H. pylori ( 9.1 ) and in those remaining free of infection ( 10.0 ) . No reinfection could be found . Conclusion These results suggest that clarithromycin plus high-dose ranitidine is a combination which achieves reasonably high H. pylori eradication rates . However , treatment failure inevitably leads to clarithromycin resistance . The improvement of non-ulcer dyspepsia symptoms during acute therapy is independent of H. pylori eradication . Long-term benefit of H. pylori eradication with respect to the symptoms of functional dyspepsia was not observed
target: Reports of strong associations in small observational studies without appropriate adjustment for potential confounding factors were not generally confirmed by larger and better- design ed studies .
  The available evidence indicates that there is no strong association between H pylori and dyspepsia , but there is insufficient evidence to confirm or refute the existence of a modest association
background: BACKGROUND Previous studies have yielded conflicting results and substantial uncertainty about any independent association of Helicobacter pylori infection with dyspepsia , and about any benefits of antibiotic treatments for nonulcer or uninvestigated dyspepsia .
  OBJECTIVES To perform a systematic review of the literature to determine whether chronic infection with H pylori is relevant to nonulcer or uninvestigated dyspepsia .