H pylori and Nonulcer Dyspepsia

H. pylori prevalence is higher in patients with nonulcer dyspepsia (NUD) compared to the general population, but it is unclear whether infection causes dyspepsia. Disparate results have been obtained from the many prospective studies assessing long term (1 year) symptom improvement in NUD patients randomized to H. pylori eradication versus placebo (or PPI) (Laine et al, 2001). The most recent Cochrane systematic review update by Moayyedi and colleagues (2003) shows a small but statistically significant benefit for eradication of H. pylori infection in the patient with NUD with a number needed to treat of 15. Similar findings were described in the prospective German multicenter ELAN study in which the therapeutic gain was only 10% in NUD patients with successful H. pylori eradication (Malfertheiner et al, 2003).

Although these studies support intervention (H. pylori eradication) in the NUD patient, one should also identify the numerous potential factors contributing to the patient's dyspepsia. Many patients will have symptom improvement immediately after successful H. pylori eradication only to develop recurrence of their dyspepsia shortly thereafter. The provider must be prepared for this "refractory" dyspepsia. Psychosocial factors are often important issues to explore in many patients with NUD.*

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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