Helicobacter pylori Infection in Rome IV Functional Dyspepsia: Association with the Epigastric Pain Syndrome Phenotype and Long-Term Response to Eradication

Background and Objectives: Functional dyspepsia (FD) is a heterogeneous disorder of gut-brain interaction with a multifactorial pathophysiology. Although Helicobacter pylori infection has been implicated in FD, its relationship with Rome IV FD subgroups and the extent to which successful eradication results in sustained symptomatic improvement remain unclear. This study aimed to evaluate the distribution of H. pylori infection across Rome IV FD subgroups and to assess long-term symptomatic response following successful eradication. Materials and Methods: This prospective, single-center observational cohort study included patients with dyspeptic symptoms who underwent evaluation according to the Rome IV criteria. Adult patients who completed the Rome IV gastroduodenal symptom questionnaire and underwent upper gastrointestinal endoscopy were evaluated. Patients fulfilling the Rome IV criteria for FD without an organic cause explaining their symptoms were classified as postprandial distress syndrome (PDS), epigastric pain syndrome (EPS), or overlapping PDS-EPS. H. pylori status was determined histopathologically using gastric antral and corpus biopsies. H. pylori-positive patients received 14-day bismuth-based quadruple therapy, and eradication was assessed using a stool antigen test 8-12 weeks after treatment. Symptomatic response was evaluated at month 2, 6, and 12 using Likert scale and clinical assessment.