Helicobacter pylori eradication improves the quality of life regardless of the treatment outcome: A multicenter prospective cohort study

Abstract

Helicobacter pylori (Hp) eradication is recommended for improving the quality of life (QOL) of patients with epigastric symptoms, especially reflux and dyspepsia. However, no reports have investigated the improvement of QOL after the eradication of Hp irrespective of epigastric symptoms. The aim of this study was to investigate the improvement in the QOL after the eradication of Hp irrespective of epigastric symptoms, and evaluate the factors associated with an improved QOL after the eradication of Hp.This prospective cohort study was performed at 15 referral institutions from September 2013 to December 2014. The patients' QOL and epigastric symptoms were evaluated before and after the eradication of Hp using the 8-item Short-Form Health Survey (SF-8) and the modified Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease, respectively.One hundred sixty-five of 184 Hp-infected patients underwent Hp eradication treatment. The treatment was successful in 82.4% (136/165) of the cases. One hundred sixty of the 165 Hp-infected patients were eligible for inclusion in the QOL analysis. In the indices of QOL on the SF-8, the scores on both the mental component summary (MCS) and the physical component summary (PCS) were found to have significantly improved after the eradication of Hp. However, the epigastric symptoms before the eradication of Hp were not correlated with either the MCS or PCS. A low QOL value before the eradication of Hp was the factor what was most strongly associated with the improvement in the QOL.The eradication of Hp improved the QOL, regardless of the outcome of the treatment, especially in patients who had an impaired QOL before the eradication.

Figure 1

The study protocol. At the “registration point” and “validation point,” the study participants whose mFSSG scores were >0 received rabeprazole (10 mg/d). Meanwhile, those whose mFSSG scores were = 0 did not receive rabeprazole (10 mg/d). Thus, the registration point and validation point (which both occurred prior to the administration of the proton pump inhibitor), were compared to analyze the condition of the patients before and after the eradication of Hp. Hp = Helicobacter pylori; mFSSG = modified Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease; PPI = proton pump inhibitors; SF-8 = 8-item Short-Form Health Survey.

Figure 2

The upper 3 figures show the changes in the epigastric symptoms among the patients in the treatment success group (N = 133); the lower 3 figures show the changes in the epigastric symptoms in the treatment failure group (N = 27). With the exception of NERD, the epigastric symptoms improved in the treatment success group. None of the epigastric symptoms improved in the treatment failure group. mFSSG = modified Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease; NERD = nonerosive reflux disease.

Figure 3

The change in the QOL following Hp eradication treatment in patients with epigastralgia (N = 127) and in the treatment success (N = 104) and treatment failure (N = 23) groups. Among total patients, both the PCS and MCS scores showed significant improvements after the eradication of Hp. In the treatment success group, although the PCS score was not improved after Hp eradication treatment, the MCS did show a significant improvement. In the treatment failure group, although the PCS score was not significantly improved after Hp eradication treatment, the MCS score did show a significant improvement. Hp = Helicobacter pylori; MCS = mental component summary; PCS = physical component summary.

Figure 4

The change in the serum Hp IgG titers of the treatment success (N = 135) and treatment failure (N = 29) groups. Hp IgG antibody titer was significantly decreased in both the treatment success and treatment failure groups; however, the grade of the decrease was significantly higher in treatment success group. Hp = Helicobacter pylori, IgG = immunoglobulin G.

Figure 5

The 3 upper figures show the changes in the PGT results in the treatment success group (N = 131); the 3 lower figures show the changes in the PGT results in treatment failure group (N = 27). The PG I and PG II values and the PG I/II ratio were significantly improved in the treatment success group, but not in the treatment failure group. PGT = pepsinogen test.