By Ralph Boulton, Sanjeev Gupta, Claire Cousins, Humphrey Hodgson
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Pylori colonization confers risk of peptic ulcer disease, and this is attenuated with eradication therapy. However, studies of H. pylori eradication in dyspeptic patients have generally been disappointing. Using symptomatic relief as an end point, H. pylori eradication in patients with uninvestigated uncomplicated dyspepsia confers a small benefit. There is an even smaller effect on dyspeptic symptoms of H. pylori eradication in those patients in whom endoscopy fails to demonstrate peptic ulcer disease (so-called ‘endoscopy-negative’ dyspepsia or nonulcer dyspepsia).
Although in an individual patient, antibody titres do fall slowly after successful H. pylori eradication, this is not helpful in assessing the success of eradication therapy. Faecal H. pylori antigen detection has been described both for diagnosis of H. pylori colonization and for assessment of eradication. Disease associations with H. pylori Duodenal ulcer There is a very strong association between chronic H. pylori infection and the development of duodenal ulceration. Up to 95% of patients with duodenal ulceration have evidence of H.
Diffuse thickening of the wall occurs from secondary changes in mucosal and smooth muscle layers. Clinical history Dysphagia This is progressive and – in contrast to most causes – characteristically presents with dysphagia for both liquids and solids from the outset. Regurgitation Postprandial regurgitation may be described as vomiting by the patient, but it is generally effortless, without retching. Regurgitation on recumbency can lead to aspiration and repeated chest infections. Younger patients may complain of retrosternal chest pain.
A Colour Handbook of Gastroenterology by Ralph Boulton, Sanjeev Gupta, Claire Cousins, Humphrey Hodgson