Lu JG, Gao YZ. Dyspepsia following Helicobacter pylori eradication: Shifts in etiology and clinical challenges. World J Gastroenterol 2026; 32(6): 115699 [DOI: 10.3748/wjg.v32.i6.115699]
Corresponding Author of This Article
Yi-Zhou Gao, PhD, Professor, Department of Environmental Hygiene, School of Public Health, Harbin Medical University, No. 157 Baojian Road, Nangang Distinct, Harbin 150081, Heilongjiang Province, China. gaoyizhou@yeah.net
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Gastroenterology & Hepatology
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Editorial
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Feb 14, 2026 (publication date) through Feb 5, 2026
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World Journal of Gastroenterology
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1007-9327
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Lu JG, Gao YZ. Dyspepsia following Helicobacter pylori eradication: Shifts in etiology and clinical challenges. World J Gastroenterol 2026; 32(6): 115699 [DOI: 10.3748/wjg.v32.i6.115699]
World J Gastroenterol. Feb 14, 2026; 32(6): 115699 Published online Feb 14, 2026. doi: 10.3748/wjg.v32.i6.115699
Dyspepsia following Helicobacter pylori eradication: Shifts in etiology and clinical challenges
Jian-Guo Lu, Yi-Zhou Gao
Jian-Guo Lu, Yi-Zhou Gao, Department of Environmental Hygiene, School of Public Health, Harbin Medical University, Harbin 150081, Heilongjiang Province, China
Jian-Guo Lu, Yi-Zhou Gao, Key Laboratory of Precision Nutrition and Health, Ministry of Education, Harbin Medical University, Harbin 150081, Heilongjiang Province, China
Author contributions: Lu JG is responsible for the concept conception and initial draft writing; Gao YZ is responsible for supervision, guidance and review.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi-Zhou Gao, PhD, Professor, Department of Environmental Hygiene, School of Public Health, Harbin Medical University, No. 157 Baojian Road, Nangang Distinct, Harbin 150081, Heilongjiang Province, China. gaoyizhou@yeah.net
Received: October 22, 2025 Revised: December 14, 2025 Accepted: December 23, 2025 Published online: February 14, 2026 Processing time: 102 Days and 20.9 Hours
Abstract
This editorial discusses a landmark 2025 retrospective cohort study by Suzuki et al using > 23000 endoscopic records from Japan’s Helicobacter pylori (H. pylori) eradication program. The study addressed the clinically significant phenomenon of persistent dyspeptic symptoms after successful bacterial eradication. Comprehensive analysis revealed that 28.7% of the patients continued to experience functional dyspepsia (defined as self-reported upper abdominal pain or bloating) after eradication, a prevalence rate indistinguishable from that of the never-infected control groups. Notably, Suzuki et al demonstrated no significant epidemiological association between dyspepsia and the risk of gastric cancer. These findings suggest that persistent symptoms may originate from multifactorial mechanisms, including post-eradication alterations in gastric acid secretion, visceral hypersensitivity, and potential gastric microbiome changes. These evidence-based insights support the implementation of stratified management approaches based on individual symptom patterns and sociodemographic characteristics, moving beyond uniform eradication protocols. This study recommends reducing emphasis on dyspepsia symptoms in revising endoscopic screening guidelines to minimize unnecessary interventions and improve medical resource efficiency. This research contributes significantly to mitigating public health anxiety regarding H. pylori infection, prevents indiscriminate antibacterial overuse, and provides a robust scientific foundation for developing more rational, evidence-based clinical decision-making frameworks for H. pylori-associated dyspepsia management.
Core Tip: Although Japan has made significant progress in Helicobacter pylori eradication and gastric cancer deaths have declined annually, many patients still suffer from dyspepsia. This challenges the traditional “test-and-eradicate” approach and places a heavy burden on patients. Suzuki et al’s large-scale study (n = 23250) revealed similar post-eradication dyspepsia prevalence (28.7%) to that in uninfected individuals, suggesting a shift from infection to functional factors, such as gastric acid secretion and visceral hypersensitivity. These findings call for individualized symptom-based management, rather than repeated eradication.
