After the publication of the Kyoto global consensus report, we are faced with a new entity called Helicobacter pylori-associated dyspepsia. How to make an appropriate diagnosis of this condition?
Paul Moayyedi: It is interesting and my opinions have changed on this. We were one of the first to do a systematic review showing that eradication of H pylori reduces dyspepsia. There is an American review by Loren Laine where it said it did not, so there is a lot of controversy. In Europe very early on we recommended H pylori eradication for anyone with functional dyspepsia who is H pylori-positive. In North America it is just now, with the guidelines this year [in 2017], where they are finally recommending it. Very much behind us, Europeans. Although the Canadians have recommended it for many years before.
Having said that, I am not sure we know that it is H pylori that is causing dyspepsia. All we are sure is that antibiotics are reducing dyspepsia. It may not be the eradication of H pylori. It may be antibiotics affecting other microorganisms within the upper gastrointestinal (GI) tract and even the duodenum and upper jejunum that are causing that modest effect. We do not know for sure that it is H pylori. We really need to do trials in H pylori-negatives with antibiotics to see if we get the same effects. If we do, that would be interesting.
I think, if we are going to be purist in our science, we should not be talking about H pylori-associated functional dyspepsia. I think it is better just to say that H pylori eradication will have a modest effect on functional dyspepsia symptoms.