Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.
J Neurogastroenterol Motil. 2013 Apr;19(2):233-43. doi: 10.5056/jnm.2013.19.2.233. Epub 2013 Apr 16.
BACKGROUND/AIMS: This study evaluated the effect of Helicobacter pylori eradication on functional dyspepsia (FD), and the relationship between the changes of histological gastritis and FD symptom responses.
A total of 213 FD patients diagnosed by Rome III criteria were consecutively enrolled. H. pylori tests and gastritis grade by the Sydney system were performed before and 1 year after the proton pump based-eradication therapy for 7 days. Serum levels of pepsinogen, and genetic polymorphisms IL-6, IL-8 and IL-10 were investigated.
Total of 91 patients completed the 1 year follow-up. When the response rate of dyspepsia was compared at 1 year between the non-eradicated group (n = 24) and eradicated group (n = 67), each group showed complete response of 62.5% and 62.7%; satisfactory response (≥ 50%) of 0.0% and 19.4%; partial response (< 50%) of 12.5% and 11.9%; and refractory response of 25.0% and 6.0%, respectively (P = 0.015). In addition, the responder group (complete + satisfactory response) at 1 year showed improvement of activity and chronic inflammation in both the antrum and corpus (all P < 0.001). Multivariate analysis showed that H. pylori eradication (OR, 5.81; 95% CI, 1.07-31.59) and symptom improvement at 3 month (OR, 28.90; 95% CI, 5.29-157.82) were associated with the improvement of dyspepsia at 1 year. Among the successfully eradicated FD patients (n = 67), male (P = 0.013) and higher initial BMI (P = 0.016) were associated with the improvement of dyspepsia at 1 year.
H. pylori eradication improved FD symptoms, as well as gastritis at 1 year, suggesting that inflammation mediates FD.
背景/目的：本研究评估了幽门螺杆菌（H. pylori）根除对功能性消化不良（FD）的影响，以及组织学胃炎变化与 FD 症状反应之间的关系。
连续纳入 213 例符合 Rome III 标准诊断的 FD 患者。在质子泵为基础的 7 天根除治疗前后，进行 H. pylori 检测和悉尼系统的胃炎分级。检测血清胃蛋白酶原水平，并研究 IL-6、IL-8 和 IL-10 的遗传多态性。
共有 91 例患者完成了 1 年随访。在非根除组（n = 24）和根除组（n = 67）的 1 年消化不良症状缓解率比较中，每组的完全缓解率分别为 62.5%和 62.7%；满意缓解率（≥50%）分别为 0.0%和 19.4%；部分缓解率（<50%）分别为 12.5%和 11.9%；难治性缓解率分别为 25.0%和 6.0%（P = 0.015）。此外，1 年时的应答组（完全+满意缓解）在胃窦和胃体均显示出活动和慢性炎症的改善（均 P < 0.001）。多变量分析显示，H. pylori 根除（OR，5.81；95%CI，1.07-31.59）和 3 个月时症状改善（OR，28.90；95%CI，5.29-157.82）与 1 年时消化不良的改善相关。在成功根除 H. pylori 的 FD 患者中（n = 67），男性（P = 0.013）和较高的初始 BMI（P = 0.016）与 1 年时消化不良的改善相关。
H. pylori 根除可改善 FD 症状和 1 年时的胃炎，表明炎症介导了 FD。
