Functional Dyspepsia vs. H. pylori Infection: When to Suspect Bacterial Infection and Consider Breath Test for Eradication Treatment
Functional dyspepsia is a common disorder affecting a significant percentage of the population, characterized by symptoms such as epigastric pain, postprandial fullness, and early satiety. Often, these symptoms are not associated with an identifiable structural cause, complicating their diagnosis and treatment. However, one of the factors that has been investigated in relation to functional dyspepsia is H. pylori infection, a bacterium that colonizes the stomach and may be implicated in the genesis of these symptoms.
The relationship between chronic dyspepsia and H. pylori infection has been the subject of numerous studies. It has been shown that the eradication of H. pylori can provide symptomatic improvement in some patients with functional dyspepsia, although the benefit is modest and not all patients respond in the same way. This suggests that H. pylori infection could be a contributing factor in a subgroup of patients, but not the primary cause in all cases.
The diagnosis of H. pylori infection is commonly performed using the breath test, which is a non-invasive and highly effective procedure. In patients under 60 years of age with dyspepsia without alarm features, a "test and treat" approach is recommended, where the breath test is conducted, and if positive, the eradication treatment for H. pylori is initiated. This approach can not only alleviate symptoms in some patients but also reduce the risk of developing more serious gastric diseases, such as peptic ulcers and gastric cancer.
Profundizando en la relación entre dispepsia funcional e infección por H. pylori
Functional dyspepsia is classified into two main clinical syndromes: epigastric pain syndrome and postprandial distress syndrome. H. pylori infection has been implicated in the pathogenesis of both syndromes, although its exact role remains a subject of debate. Some studies have suggested that the eradication of H. pylori may be more effective in patients with microscopic duodenal inflammation, indicating that the effects of antibiotics may extend beyond the simple eradication of the gastric bacterium.
In terms of treatment, proton pump inhibitors (PPIs) and prokinetic agents are common therapeutic options for functional dyspepsia. However, the eradication of H. pylori remains the only intervention that has demonstrated the ability to change the natural history of functional dyspepsia in some patients. Identifying subgroups of patients who may benefit most from H. pylori eradication is an active area of research and could lead to more personalized treatment approaches in the future.
Conclusiones
The relationship between functional dyspepsia and H. pylori infection is complex and multifaceted. Although the eradication of H. pylori may offer symptomatic benefits in some patients, it is not a universal solution for all cases of functional dyspepsia. Identifying patients who may benefit most from this approach is crucial for optimizing treatment and improving patients' quality of life. Ongoing research in this area is essential for developing more effective and personalized treatment strategies.
Referencias
- [1] ACG and CAG Clinical Guideline: Management of Dyspepsia
- [2] Functional dyspepsia
- [3] United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on functional dyspepsia
- [4] Helicobacter pylori and functional dyspepsia: an unsolved issue?
- [5] Helicobacter pylori eradication therapy for functional dyspepsia: Systematic review and meta-analysis
Created 6/1/2025