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Invited Commentary
Nov 28, 2011

Helicobacter pylori Eradication for Functional Dyspepsia: What Are We Treating?Comment on “Helicobacter pylori Eradication in Functional Dyspepsia”

Author Affiliations

Author Affiliation: Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

Arch Intern Med. 2011;171(21):1936-1937. doi:10.1001/archinternmed.2011.541

Functional dyspepsia is a major burden to society. Upper gastrointestinal tract symptoms account for 5% of all primary care visits,1 and about 80% of patients with epigastric pain have a normal result from endoscopy.2,3 The cost of investigating and treating this disorder is significant, and it is estimated that the US health care system spends over $1 billion per year on functional dyspepsia.1,4 Despite this drain on resources, there are few therapeutic options for patients with functional dyspepsia. A systematic review4 suggests that prokinetic therapy may have some benefit, but this is driven by small positive studies with the larger studies being negative, and any effect seen in the meta-analysis may be due to publication bias.5 Acid suppression with proton pump inhibitor therapy has modest efficacy in functional dyspepsia,6 and this may be due to the treatment of atypical gastroesophageal reflux disease.7 Given the paucity of effective therapies, it is important to establish whether eradicating Helicobacter pylori in those infected will have any benefit in functional dyspepsia.