Effect of Helicobacter pylori eradication on gastric histology and symptom resolution in functional dyspepsia: a preliminary follow-up study

Background: Functional dyspepsia (FD) is a prevalent gastrointestinal condition with a multifactorial origin, in which Helicobacter pylori infection may play a contributory role. Although eradication therapy has been shown to offer symptomatic relief in a subset of patients, predictors of response remain inadequately defined. To evaluate the effect of H. pylori eradication on gastric histological parameters and symptom resolution in patients with functional dyspepsia and to identify histopathological predictors of treatment response. Methods: This prospective observational study included 121 adult patients with functional dyspepsia and confirmed H. pylori infection. All patients underwent upper gastrointestinal endoscopy and gastric biopsies were obtained before initiating eradication therapy. Biopsy specimens were stained with H&E and Giemsa and histological assessment was performed by a blinded pathologist using the Modified Sydney System. Parameters assessed included chronic inflammation, neutrophilic activity, glandular atrophy, intestinal metaplasia and H. pylori density. A composite Sydney score was calculated. Follow-up was conducted at 3 months to assess symptom resolution. Patients were categorized into "Resolved" and "Non-improved" groups based on symptomatic outcomes. Results: Out of 100 patients enrolled, follow-up data were available for 79. Symptom resolution was observed in 52 patients (51.5%), while 27 (26.7%) reported no improvement. Patients with symptom resolution had significantly higher pre-treatment scores for chronic inflammation (p=0.012), neutrophilic activity (p=0.021), H. pylori density (p=0.008) and composite Sydney score (p=0.002). Glandular atrophy (p=0.486) and intestinal metaplasia (p=0.671) showed no significant association with symptomatic improvement. Conclusions: Symptomatic benefit following H. pylori eradication in functional dyspepsia appears to be associated with higher baseline levels of chronic and active gastric inflammation, as well as H. pylori density. Histopathological assessment using the Modified Sydney System may help predict treatment response and guide clinical decision-making.