Epidemiology of dyspepsia and esophagogastroduodenoscopic findings in the era of Helicobacter pylori eradication

BACKGROUND Since Japanese national insurance coverage was expanded to include Helicobacter pylori (H. pylori ) gastritis in 2013, approximately 1.5 million patients have received eradication therapy annually. However, the prevalence and clinical features of uninvestigated dyspepsia in the post-eradication era remain unclear. AIM To evaluate the prevalence of dyspepsia and related endoscopic findings in the general population. METHODS We analyzed data from a gastric cancer screening program using esophagogastroduodenoscopy in Sendai city between 2019 and 2021. Data regarding endoscopic findings, upper gastrointestinal symptoms, and history of H. pylori eradication were collected. Dyspepsia was defined as the presence of upper abdominal pain, bloating, or both. Multivariate logistic regression was used to identify independent factors associated with dyspepsia. RESULTS Among 23250 participants, overall dyspepsia prevalence was 28.0%. It was 28.7% in the non-infected and post-eradication cohorts, and lower (25.8%, P < 0.05) in the currently infected or naturally eradicated cohort. In addition, 23.1% of participants reported heartburn. The following were independently associated with dyspepsia: Age < 60 years, female sex, gastric ulcers, duodenal ulcers, erosive esophagitis, a history of gastric surgery, and successful H. pylori eradication. Gastric or esophageal cancer showed no association. CONCLUSION Uninvestigated dyspepsia remains common even after successful H. pylori eradication. Dyspepsia was not considered a reliable indicator of gastric or esophageal cancer.