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New Studies Cast Doubt on Treatments for Dyspepsia, Pancreatitis: Presented at ACP

By K.L. Capozza

SAN FRANCISCO, CA -- April 18, 2005 -- Helicobacter pylori may no longer be implicated in non-ulcer dyspepsia and gastric cancer.

New research that casts doubt on the bacteria's association with these conditions was discussed here on April 16^th at the American College of Physicians annual session (ACP).

Dyspepsia is a common condition that affects approximately 30% of Americans and accounts for 2% to 5% of all visits to family physicians. When endoscopy shows such patients to be ulcer-free, they are classified as having non-ulcer dyspepsia (NUD).

There has been speculation that Helicobacter pylori infection may contribute to NUD and that treatment of the bacteria might alleviate symptoms. However, a 2003 study in American Journal of Gastroenterology questioned the usefulness of H. pylori eradication as a treatment strategy.

The meta-analysis of 12 studies found a very small benefit for eradicating H. pylori in patients with NUD. But the effect was so small that the potential gain must be weighed against the potential adverse effects of using antibiotics for the condition.

"Not only could H. pylori become resistant [to antibiotics], but all other bacteria that happen to be in the patient's body will also become resistant," said Ronald Koretz, MD, professor of clinical medicine at University of California, Los Angeles, California, United States, during his presentation at the ACP-ASIM meeting.

H pylori has been linked to gastric cancer, and a 2004 study in the journal JAMA explored the outcomes in patients who received eradication treatment of this bacterium as a prevention strategy. The prospective trial of 1,630 H. pylori carriers randomized subjects into two groups -- those who received H pylori eradication and those given a placebo -- and followed them for 7.5 years.

"When the dust settled…the study found the difference [gastric cancer rates] between the two groups was not statistically significant," Dr. Koretz said.

The findings may eventually exonerate H. pylori of its role in gastric cancer, he said.

Studies cited:
Moayyedi P et al. An update of the Cochrane systematic review of Helicobacter pylori eradication therapy in nonulcer dyspepsia: resolving the discrepancy between systematic reviews. Am J Gastroenterol December 2003;98(12):2621.
Wong BC-Y et al. Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of China. A randomized control trial. JAMA 2004;291:187-194.


[Session title: Update in Gastroenterology and Hepatology]

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