Medical Health Encyclopedia

Arguments for Testing and Treating Patients with Dyspepsia. The argument supporting testing and treating patients with non-ulcer dyspepsia are as follows:

• Protection against ulcers. Some evidence suggests that antibiotic treatments for infected patients with dyspepsia may prevent ulcers from developing. A study in 2002, for example, found that antibiotic regimens to eradicate H. pylori greatly decreased the likelihood of ulcers in infected patients with nonulcer dyspepsia who were also on long-term NSAIDs.
• Protection against gastric cancer. Some evidence suggests that eradicating H. pylori may prevent or delay the onset of stomach cancer in people with long-term dyspepsia who are infected with the bacteria. For example, a large 2001 study in Japan, where gastric cancer is especially common, found that such cancers developed in about 3% of infected patients with nonulcer dyspepsia. However, none occurred in dyspeptic patients who were treated with antibiotics for H. pylori.

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Arguments Against Testing and Treating Patients with Dyspepsia. The arguments against testing and treating are as follows:

• Lack of significant effect on symptoms. Studies are mixed on whether antibiotics have much effect on dyspepsia symptoms. For example, in a 2003 study, overall symptom scores after a year where not significantly different between dyspeptic patients who were treated for H. pylori and patients who were maintained on PPIs.
• Lower rates of H. pylori in the US. The numbers of people with H. pylori infection is declining in the US, possibly making the test-and-treat approach too expensive considering the number of people it helps.
• Increased risk for gastroesophageal reflux disease (GERD). A number of studies suggest that H. pylori in the intestinal tract protects against gastroesophageal reflux disease (GERD), which in severe cases, can be a risk factor for cancer in the esophagus. Eliminating H. pylori may also have other adverse effects.
• Overuse of antibiotics. Concern that such treatments without clear evidence of ulcers will lead to unnecessary antibiotic prescriptions, increasing the risk for side effects. Overuse may also contribute to a growing public health problem--the emergence of bacteria that are resistant to antibiotics.

Antibiotic and Combination Drug Regimens for Patients with Clear Evidence of Ulcers