Antibiotics reduced dyspepsia symptoms for some primary care patients

Antibiotic treatment of Helicobacter pylori reduced symptoms of functional dyspepsia for some primary care patients, a new study found.

The trial randomized about 400 Brazilian patients with functional dyspepsia who had tested positive for H. pylori to treatment with either placebo or amoxicillin trihydrate and clarithromycin for 10 days. All patients also received omeprazole. Endoscopy and H. pylori testing were performed at the start and after 12 months. The primary outcome was at least 50% symptomatic improvement at 12 months as assessed by a disease-specific questionnaire. The results appeared in the Nov. 28 Archives of Internal Medicine.

At one year, the primary outcome was achieved in 49% of the antibiotics group compared to 36.5% of the control group (P=0.01). The patients in the antibiotic group were also more likely to report improvement in their global assessment of symptoms (78.1% vs. 67.5%; P=0.02). Their mean scores on the Medical Outcomes Study 36-Item Short Form Health Survey also increased more than controls' did (4.15 vs. 2.2; P=0.02).

This study may be the largest trial to date of H. pylori eradication as treatment for functional dyspepsia, the study authors said. Although the benefit to patients was relatively small, it is comparable to that shown by long-standing proton-pump inhibition, they noted. Antibiotic treatment also holds the advantage of being short term, and therefore potentially very cost-effective. The authors calculated a number needed to treat of 8.

The findings of this study are consistent with the results of a previous Cochrane review, according to an invited commentary published with the study. However, researchers have not uncovered the mechanism by which the antibiotics were successful in reducing dyspepsia, the commentary author noted. It's possible that the drugs work by treating a chronic inflammation in the patients' gastric mucosa, one that could be caused by organisms other than H. pylori, the author speculated. To study this theory, future trials could also try the antibiotic therapy in patients negative for H pylori.