H pylori Eradication Therapy May Improve Functional Dyspepsia Symptoms

Investigators assessed the efficacy of eradication therapy for the treatment of patients with H pylori-positive functional dyspepsia.

Helicobacter pylori (H pylori) eradication therapy may be effective for improving symptoms in patients with functional dyspepsia (FD), according to a study in Gut.

The updated systemic review and meta-analysis evaluated the efficacy of eradication therapy for the treatment of patients with H pylori-positive FD. Investigators searched MEDLINE, EMBASE, and EMBASE Classic through October 2021, as well as the Cochrane Central Register of Controlled Trials.

Eligible studies were randomized controlled trials (RCTs) that examined the effects of at least 1 week of eradication therapy on symptoms of FD in H pylori-positive adults aged 16 years and older with 3 months or more of follow-up.

The primary outcome was the effect of H pylori eradication therapy vs antisecretory therapy or prokinetics, with or without placebo antibiotics, or placebo alone regarding cure or improvement of FD symptoms.

The analysis included 29 trials with 6781 patients. Based on 18 RCTs reporting on cure of symptoms, the relative risk (RR) of FD symptoms not being cured with eradication therapy compared with the control treatment was 0.91 (95% CI, 0.88-0.94), and the number needed to treat (NNT) was 14 (95% CI, 11-21).

In 22 trials that reported on improvement of FD symptoms, the RR of FD symptoms not improving with eradication therapy vs control treatment was 0.84 (95% CI, 0.78-0.91), and the NNT was 9 (95% CI, 7-17). No significant correlation was observed between eradication rate and RR of FD improving or being cured (Pearson correlation coefficient, -0.23; P =.907).

In 13 RCTs with 1259 patients, the RR of symptoms not being cured or not improving with successful vs unsuccessful eradication of H pylori was 0.65 (95% CI, 0.52-0.82; I2=79%; P <.001). The NNT was 4.5 (95% CI, 3-9).

Adverse events occurred significantly more frequently with eradication therapy (RR, 2.19; 95% CI, 1.10-4.37), and withdrawals due to adverse events were significantly more likely to occur with eradication therapy (RR, 2.60; 95% CI, 1.47-4.58).

Among several study limitations, only 6 trials were regarded as being at low risk for bias across all domains, and heterogeneity existed among studies assessing the effect of H pylori eradication therapy on symptom improvement. Evidence of publication bias was observed in some of the analyses, and the eradication regimens varied considerably among the individual trials.

“Our updated systematic review and meta-analysis provides high-quality evidence that eradication therapy is an efficacious treatment for H pylori-positive patients with FD and should, therefore, be first-line therapy in such patients,” the study authors commented. “It is likely that this would be a cost-effective treatment for FD, and it would only need to be applied as a single intervention.”


Ford AC, Tsipotis E, Yuan Y, Leontiadis GI, Moayyedi P. Efficacy of Helicobacter pylori eradication therapy for functional dyspepsia: updated systematic review and meta-analysis. Gut. Published online January 12, 2022. doi: 10.1136/gutjnl-2021-326583