Helicobacter pylori Infection Impacts on Functional Dyspepsia in Thailand

  • Published : 2015.01.22


Background: Helicobacter pylori (H. pylori) is a well known major cause of gastric cancer and even when asymptomatic infected patients are at elevated risk. Functional dyspepsia (FD) is also one of the most common gastrointestinal diseases, which greatly impacts the quality of life. H. pylori infection and psychosocial stress are frequently associated with FD but limited studies have confirmed the relationships, especially in Southeast Asian countries. Here we aimed to investigate the prevalence and impact of H. pylori infection, anxiety and depression on Thai FD patients. Materials and Methods: This cross-sectional study was conducted in a tertiary care center in Thailand, during February 2013-January 2014. All FD patients were diagnosed and categorized by Rome III criteria into epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS) groups. The Hospital Anxiety and Depression Scale was used to evaluate psychological status. The presence of H. pylori was defined as positive with H. pylori culture, positive rapid urease test or positive histology. Results: Three hundred FD patients were included, 174 (58%) female. Overall mean age was 54.8+15.1 years. There were 192 (64%) patients with PDS and 108 (36%) with EPS. H. pylori infection was demonstrated in 70 (23.3%) patients. Anxiety and depression were documented in 69 (23%) and 22 (7.3%), respectively. H. pylori infection, anxiety and depression were significantly higher in PDS than EPS patients (27.1% vs 16.7%; p=0.04; OR=1.86; 95%CI=1.01-3.53 and 29.7% vs 11.1%; p=0.0002; OR=3.4; 95%CI=1.7-7.1 and 10.4% vs 1.9%; p=0.006; OR=6.2; 95%CI=1.4-38.9, respectively). Conclusions: H. pylori infection, anxiety and depression were commonly found in Thai FD patients and more prevalent in PDS than EPS. H. pylori eradication might be the key to success for the treatment of Thai FD patients and prevent the development of gastric cancer.



  1. Arisawa T, Tahara T, Shibata T, et al (2008). Genetic polymorphisms of cyclooxygenase-1 (COX-1) are associated with functional dyspepsia in Japanese women. J Womens Health (Larchmt), 17, 1039-43.
  2. Baron JH, Sonnenberg A (2008). Hospital admissions and primary care attendances for nonulcer dyspepsia, reflux oesophagitis and peptic ulcer in Scotland 1981-2004. Eur J Gastroenterol Hepatol, 20, 180-6.
  3. Basiri Z, Safaralizadeh R, Bonyadi MJ, et al (2014). Helicobacter pylori vacA d1 genotype predicts risk of gastric adenocarcinoma and peptic ulcers in northwestern Iran. Asian Pac J Cancer Prev, 15, 1575-9.
  4. Dai F, Liu Y, Shi H, et al (2014). Association of genetic variants in GNbeta3 with functional dyspepsia: a meta-analysis. Dig Dis Sci, 59, 1823-30.
  5. Drossman DA, Creed FH, Olden KW, et al (1999). Psychosocial aspects of the functional gastrointestinal disorders. Gut, 45, 25-30.
  6. Filipovic BF, Randjelovic T, Ille T, et al (2013). Anxiety, personality traits and quality of life in functional dyspepsiasuffering patients. Eur J Intern Med, 24, 83-6.
  7. Fischler B, Tack J, De Gucht V, et al (2003). Heterogeneity of symptom pattern, psychosocial factors, and pathophysiological mechanisms in severe functional dyspepsia. Gastroenterology, 124, 903-10.
  8. Ford AC (2012). Eradicating Helicobacter pylori in functional dyspepsia. Gastroenterology, 142, 1613-4.
  9. Ford AC, Forman D, Hunt RH, et al (2014). Helicobacter pylori eradication therapy to prevent gastric cancer in healthy asymptomatic infected individuals: systematic review and meta-analysis of randomised controlled trials. BMJ, 348, 3174.
  10. Forman D, Newell DG, Fullerton F, et al (1991). Association between infection with Helicobacter pylori and risk of gastric cancer: evidence from a prospective investigation. BMJ, 302, 1302-5.
  11. Gimenez-Palop O, R Coronas, J Cobo, et al (2012). Fasting plasma peptide YY concentrations are increased in patients with major depression who associate weight loss. J Endocrinol Invest, 35, 645-8.
  12. Hamajima N, Goto Y, Nishio K, et al (2004). Helicobacter pylori eradication as a preventive tool against gastric cancer. Asian Pac J Cancer Prev, 5, 246-52.
  13. Haug TT, S Svebak, I Wilhelmsen, et al (1994). Psychological factors and somatic symptoms in functional dyspepsia. A comparison with duodenal ulcer and healthy controls. J Psychosom Res, 38, 281-91.
  14. Haug TT, Wilhelmsen I, Berstad A, Ursin H (1995). Life events and stress in patients with functional dyspepsia compared with patients with duodenal ulcer and healthy controls. Scand J Gastroenterol, 30, 524-30.
  15. Hojo M, Miwa H, Yokoyama T, et al (2005). Treatment of functional dyspepsia with antianxiety or antidepressive agents: systematic review. J Gastroenterol, 40, 1036-42.
  16. Jin X, Li YM (2007). Systematic review and meta-analysis from Chinese literature: the association between Helicobacter pylori eradication and improvement of functional dyspepsia. Helicobacter, 12, 541-6.
  17. Karami N, Talebkhan Y, Saberi S, et al (2013). Seroreactivity to Helicobacter pylori antigens as a risk indicator of gastric cancer. Asian Pac J Cancer Prev, 14, 1813-7.
  18. Khoo J, CK Rayner, C Feinle-Bisset, et al (2010). Gastrointestinal hormonal dysfunction in gastroparesis and functional dyspepsia. Neurogastroenterol Motil, 22, 1270-8.
  19. Kim SE, Park YS, Kim N, et al (2013). Effect of Helicobacter pylori eradication on functional dyspepsia. J Neurogastroenterol Motil, 19, 233-43.
  20. Koloski NA, Jones M, Kalantar J, et al (2012). The braingut pathway in functional gastrointestinal disorders is bidirectional: a 12-year prospective population-based study. Gut, 61, 1284-90.
  21. Lee KJ, Tack J (2010). Duodenal implications in the pathophysiology of functional dyspepsia. J Neurogastroenterol Motil, 16, 251-7.
  22. Li D, Yuan Y, Sun LP, et al (2014). Health economics evaluation of a gastric cancer early detection and treatment program in China. Asian Pac J Cancer Prev, 15, 5133-6.
  23. Li Y, Nie Y, Sha W, Su H (2002). The link between psychosocial factors and functional dyspepsia: an epidemiological study. Chin Med J, 115, 1082-4.
  24. Locke GR 3rd, Weaver AL, Melton LJ 3rd, Talley NJ (2004). Psychosocial factors are linked to functional gastrointestinal disorders: a population based nested case-control study. Am J Gastroenterol, 99, 350-7.
  25. Magni G, di Mario F, Bernasconi G, Mastropaolo G (1987). DSM-III diagnoses associated with dyspepsia of unknown cause. Am J Psychiatry, 144, 1222-3.
  26. Mahadeva S, Goh KL (2006). Epidemiology of functional dyspepsia: a global perspective. World J Gastroenterol, 12, 2661-6.
  27. Mahadeva S, Goh KL (2011). Anxiety, depression and quality of life differences between functional and organic dyspepsia. J Gastroenterol Hepatol, 26, 49-52.
  28. Mertz H, Fass R, Kodner A, et al (1998). Effect of amitriptyline on symptoms, sleep, and visceral perception in patients with functional dyspepsia. Am J Gastroenterol, 93, 160-5.
  29. Mimidis K, Tack J (2008). Pathogenesis of dyspepsia. Dig Dis, 26, 194-202.
  30. Min BH, Huh KC, Jung HK, et al (2014). Prevalence of uninvestigated dyspepsia and gastroesophageal reflux disease in Korea: a population-based study using the Rome III Criteria. Dig Dis Sci, 59, 2721-9.
  31. Miwa H, Ghoshal UC, Gonlachanvit S, et al (2012). Asian consensus report on functional dyspepsia. J Neurogastroenterol Motil, 18, 150-68.
  32. Moayyedi P, Soo S, Deeks J, et al (2006). Eradication of Helicobacter pylori for non-ulcer dyspepsia. Cochrane Database Syst Rev, 19, CD002096.
  33. Nomura A, GN Stemmermann, PH Chyou, et al (1991). Helicobacter pylori infection and gastric carcinoma among Japanese Americans in Hawaii. N Engl J Med, 325, 1132-6.
  34. Otaka M, Jin M, Odashima M, et al (2005). New strategy of therapy for functional dyspepsia using famotidine, mosapride and amitriptyline. Aliment Pharmacol Ther, 21, 42-6.
  35. Park H (2011). Functional gastrointestinal disorders and overlap syndrome in Korea. J Gastroenterol Hepatol, 26, 12-4.
  36. Parsonnet J, Friedman GD, Vandersteen DP, et al (1991). Helicobacter pylori infection and the risk of gastric carcinoma. N Engl J Med, 325, 1127-31.
  37. Raymond J, Lamarque D, Kalach N, et al (2010). High level of antimicrobial resistance in French Helicobacter pylori isolates. Helicobacter, 15, 21-7.
  38. Shaib Y, El-Serag HB (2004). The prevalence and risk factors of functional dyspepsia in a multiethnic population in the United States. Am J Gastroenterol, 99, 2210-6.
  39. Su P, Li Y, Li H, et al (2013). Antibiotic resistance of Helicobacter pylori isolated in the southeast coastal region of China. Helicobacter, 18, 274-9.
  40. Tack J, Talley NJ, Camilleri M, et al (2006). Functional gastroduodenal disorders. Gastroenterology, 130, 1466-79.
  41. Tahara T, Arisawa T, Shibata T, et al (2008). COMT gene val158met polymorphism in patients with dyspeptic symptoms. Hepatogastroenterology, 55, 979-82.
  42. Talley NJ, Vakil NB, Moayyedi P (2005). American gastroenterological association technical review on the evaluation of dyspepsia. Gastroenterology, 129, 1756-80.
  43. Tan VP, Cheung TK, Wong WM, et al (2012). Treatment of functional dyspepsia with sertraline: a double-blind randomized placebo-controlled pilot study. World J Gastroenterol, 18, 6127-33.
  44. Tsubono Y, Nishino Y, Tsuji I, Hisamichi S (2000). Screening for gastric cancer in Miyagi, Japan: evaluation with a population-based cancer registry. Asian Pac J Cancer Prev, 1, 57-60.
  45. van Kerkhoven LA, Laheij RJ, Aparicio N, et al (2008). Effect of the antidepressant venlafaxine in functional dyspepsia: a randomized, double-blind, placebo-controlled trial. Clin Gastroenterol Hepatol, 6, 746-52, 718.
  46. Vilaichone RK, Gumnarai P, Ratanachu-Ek T, Mahachai V (2013). Nationwide survey of Helicobacter pylori antibiotic resistance in Thailand. Diagn Microbiol Infect Dis, 77, 346-9.
  47. Vilaichone RK, Mahacahai V, Tumwasorn S, Kachintorn U (2011). CagA genotype and metronidazole resistant strain of Helicobacter pylori in functional dyspepsia in Thailand. J Gastroenterol Hepatol, 26, 46-8.
  48. Vilaichone RK, Yamaoka Y, Shiota S, et al (2013). Antibiotics resistance rate of Helicobacter pylori in Bhutan. World J Gastroenterol, 19, 5508-12.
  49. Zhao Y, Wang J, Tanaka T, et al (2012). Association between HLA-DQ genotypes and haplotypes vs Helicobacter pylori infection in an Indonesian population. Asian Pac J Cancer Prev, 13, 1247-51.
  50. Zigmond AS, Snaith RP (1983). The hospital anxiety and depression scale. Acta Psychiatr Scand, 67, 361-70.

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