Persistent Dyspepsia After Confirmed Helicobacter pylori Eradication in a Prospective Saudi Cohort
Keywords:
Helicobacter pylori, dyspepsia, Rome IV, anxiety, postprandial distress syndrome, epigastric pain syndrome, prospective cohortAbstract
Background: Even if Helicobacter pylori can be treated successfully, symptoms of dyspepsia can persist. It is important to distinguish persistence of symptoms from persistent infection, because continuing symptoms do not necessarily indicate eradication failure. In this 12-month study, patients with confirmed eradication were described with dyspepsia as the outcome and the characteristics which were associated with persistent dyspepsia were examined.
Methods: 260 adult patients with chronic dyspepsia who achieved laboratory-confirmed eradication after bismuth quadruple therapy formed a prospective cohort at Alnoor Specialist Hospital in Makkah, Saudi Arabia. Symptoms were assessed before treatment and re-evaluated at 3, 6 and 12 months after eradication was confirmed, based on Rome IV criteria and with the aid of PAGI-SYM. A PAGI-SYM score >3 defined moderate-to-severe symptom burden in this study. A HADS-A score of ≥8 was considered elevated anxiety symptoms. Follow-up proportions, Wilson confidence intervals and missing-outcome bounds were calculated. Multivariable modified Poisson regression was used to examine factors associated with 12-month persistent dyspepsia.
Results: Of 331 persons who were initially evaluated, 260 were included in the confirmed-eradication cohort. Persistent dyspepsia affected 171/256 participants at 3 months (66.8%; 95% CI 60.8–72.3), 131/243 at 6 months (53.9%; 47.6–60.1) and 85/236 at 12 months (36.0%; 30.2–42.3). At 12 months, 236 of 260 participants (90.8%) completed assessment. Persistence occurred in 35/101 participants with baseline postprandial distress, 27/88 with epigastric pain and 23/47 with overlapping phenotypes. The crude risk ratio of overlap versus epigastric pain was 1.59 (95% CI 1.04–2.45). Adjusted associations included elevated anxiety symptoms (aRR 1.60; 95% CI 1.10–2.33), phenotype overlap (1.60; 1.04–2.45) and age per decade (1.15; 1.01–1.32). Extreme-case bounds for 12-month persistence were 32.7–41.9% of the original cohort.
Conclusions: After confirmed eradication, about one-third of the patients who were assessed continued to experience dyspepsia after 12 months. Further studies are warranted to assess anxiety symptoms and overlapping dyspepsia phenotypes as markers of persistence. The observational design limits causal interpretation, and the adjusted associations require further validation.
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