Functional dyspepsia persisting after H. pylori eradication therapy
This protocol addresses functional dyspepsia (FD) in patients with confirmed Helicobacter pylori infection who completed a course of eradication therapy but did not achieve resolution of dyspeptic symptoms at 12 months.
Clinical scenario
Helicobacter pylori infection is established in this patient with functional dyspepsia. Eradication therapy is an efficacious treatment for H. pylori-positive patients with FD — yet a subset of patients continues to experience symptoms despite successful eradication.
Previous line did not meet its goal
Prior therapy: Eradication therapy for Helicobacter pylori infection (1–2 week course).
Goal not reached: Cure of functional dyspepsia symptoms, assessed at 12 months.
This protocol defines the recommended next step when that threshold is not met.
Next-line approach (partial — full regimen below)
The approach for this situation includes lifestyle-based interventions. Regular aerobic exercise is a component of the recommended strategy, along with guidance on avoiding known dietary triggers. The complete structured regimen specifies further details not shown here.
References
DOI: 10.1136/gutjnl-2022-327737
Eradication therapy is an efficacious treatment for H. pylori-positive patients with FD.
We recommend that all patients with FD are advised to take regular aerobic exercise (recommendation: strong, quality of evidence: very low).
Triggers may include spicy food or alcohol, for example, but there is insufficient evidence to recommend specific dietary therapies, including a diet low in fermentable oligosaccharides, di- and monosaccharides, and polyols in FD.
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