From the Guidelines
The patient's symptoms of early fullness and constant nausea 3 days after completing H. pylori quadruple therapy are likely related to functional dyspepsia (FD), which can be triggered by issues with the two-way communication between the upper gut and the brain, as well as problems with the nerves supplying the stomach and duodenum, as stated in the British Society of Gastroenterology guidelines on the management of FD 1. Given the recent completion of H. pylori treatment, it is essential to consider the potential for ongoing gastrointestinal symptoms. The guidelines suggest that patients with FD may experience symptoms such as feeling abnormally full-up early on in a meal, or experiencing a heaviness in the abdomen that may be worse after eating 1.
- The patient should be advised to make lifestyle changes, such as regular exercise and avoiding certain foods that may trigger symptoms, as these can be helpful in managing FD symptoms 1.
- There is no evidence to support specialized diets for treating FD, and restricting diet too much could lead to malnutrition or abnormal eating habits 1.
- Medications that reduce stomach acid or help the stomach empty more quickly may be beneficial, as well as neuromodulators that help reduce the abnormal sensitivity of the nerves in the upper gut 1.
- Psychological or behavioural therapies may also be beneficial for treating symptoms in FD, as they use the connection between the brain and upper gut nerves to influence each other 1.
- If symptoms persist or worsen, the patient should be referred to a specialist for further evaluation and management, which may include a multidisciplinary team of specialists, including GPs, dietitians, gastroenterologists, and psychologists 1.
From the Research
Symptoms after H. pylori Treatment
- Early fullness and nausea are common symptoms that can occur after finishing H. pylori treatment 2, 3.
- These symptoms can be caused by various factors, including the treatment itself or the underlying condition being treated.
- It is essential to note that H. pylori eradication therapy can cause side effects, and the symptoms experienced by the patient may be related to the treatment 4, 5.
H. pylori Treatment Options
- Bismuth quadruple therapy is recommended as the best initial empiric treatment for H. pylori infection 2, 3.
- Other treatment options, such as concomitant, sequential, and hybrid therapies, can be effective in eradicating H. pylori 2.
- The choice of treatment should be based on regional resistance patterns and prior antibiotic exposure 6, 3.
Management of Symptoms
- Patients experiencing symptoms after H. pylori treatment should be evaluated to determine the cause of their symptoms 3.
- Management of symptoms may involve adjusting the treatment regimen or providing supportive care to alleviate symptoms 4, 5.
- It is crucial to test for eradication after treatment to ensure that the H. pylori infection has been successfully treated 6, 3.