Non-ulcer dyspepsia and short term De-Nol therapy: a placebo controlled trial with particular reference to the role of Campylobacter pylori.

This double blind randomised study tested the effectiveness of colloidal bismuth subcitrate (De-Nol) in non-ulcer dyspepsia (NUD) and if any benefit is associated with clearance of Campylobacter pylori (C pylori) from the gastric mucosa. Sixty six patients with dyspepsic symptoms, normal abdominal ultrasound, and upper GI endoscopy, were randomly allocated to placebo or De-Nol for eight weeks. Antral biopsies were taken for bacteriological and histological examination, and endoscopies and clinical questionnaires were administered before and after treatment. Fifty two patients (25 on De-Nol and 27 on placebo) completed the trial. De-Nol cleared C pylori from 10 of the 12 C pylori positive patients (83.3%), whereas placebo did not clear C pylori from any of the eight C pylori positive patients (p less than 0.01). In patients receiving De-Nol gastritis improved (p less than 0.01) and symptomatic response was better (p less than 0.001) compared with placebo. In the placebo group seven of the 19 C pylori negative patients became positive: this was associated with significant deterioration of symptoms, a phenomenon not seen in the De-Nol treated group.

Campylobacter pylori and non-ulcer dyspepsia.

Non-ulcer dyspepsia (NUD) is a poorly understood syndrome often present in association with gastritis. Among patients undergoing gastroscopy, some with NUD have a gastric mucosa colonized by the campylobacter-like organism, Campylobacter pylori. We therefore studied prospectively 55 consecutive patients with NUD and 15 normal controls to determine the prevalence of C. pylori organisms, and to investigate their association with histological gastritis, macroscopic evidence of gastritis, sex, smoking, alcohol consumption, and dyspeptic symptoms. We found a 45.4% prevalence in NUD patients which was statistically significantly higher than the 13.33% prevalence in the control group (p less than 0.05). We also found a close association between C. pylori and microscopic evidence of gastritis (p less than 0.001), male sex (p less than 0.001), and postprandial bloating (p less than 0.05). We did not find any significant association between C. pylori and macroscopic evidence of gastritis, smoking, alcohol consumption and other dyspeptic symptoms. Our findings suggest that C. pylori may play a pathogenic role in NUD.

The role of shorter than 24-h pH monitoring periods in the diagnosis of gastro-oesophageal reflux.

We studied 20 patients with typical symptoms of gastro-oesophageal reflux, to determine whether the diagnostic accuracy of 24-h pH monitoring might be retained in a test using a shorter time. The duration and number of reflux episodes were used to calculate a frequency and duration score (FDS) for the 24-h period, the daytime period, the nighttime period, a 3-h postprandial period after eating a test meal (provocation test), and a 21-h period that excluded this 3-h postprandial period. The daytime FDS was significantly higher than nighttime FDS (p less than 0.02), and there was good correlation between the 21-h FDS and the 3-h postprandial FDS (rs = 0.695; p less than 0.01). We conclude that the 3-h postprandial testing after a standard meal provocation test is a practical, accurate, and well-tolerated method of diagnosing gastro-oesophageal reflux. The results also demonstrated the relative importance of daytime as opposed to nocturnal reflux in producing symptoms and oesophagitis.