Functional
dyspepsia is the most common reason for patients to experience chronic epigastric
pain or discomfort. The causes of functional
dyspepsia are multifactorial but Helicobacter pylori
infection is one likely candidate.
Infection with this bacterial pathogen clearly results in chronic mucosal
inflammation in the stomach and duodenum, which, in turn, might lead to abnormalities in gastroduodenal motility and sensitivity. Chronic
gastritis might also affect a variety of endocrine functions of the stomach including the production of the
gastrointestinal hormones and
neurotransmitters somatostatin,
gastrin and
ghrelin. Although these abnormalities might generate symptoms in some patients with functional
dyspepsia, the clinical evidence needs to be critically evaluated before this hypothesis can be confirmed. A Cochrane review reported that eradication of H. pylori in these patients had a small but statistically significant long-term effect on symptom relief when compared with placebo, lasting at least 12 months after 1 week of eradication
therapy. The efficacy of eradication
therapy was seen in all symptom subtypes of functional
dyspepsia, but was more marked in Asian than Western patients. This evidence has led to alterations in most of the major guidelines throughout the world, which now recommend H. pylori eradication in patients with functional
dyspepsia if they test positive for this bacterium.