J Gastroenterol 2009; 44:66–70 DOI 10.1007/s00535-008-2271-9 Does Helicobacter pylori-induced inflammation of gastric mucosa determine the severity of symptoms in functional dyspepsia? EBRU TURKKAN 1 , IHSAN USLAN 2 , GURSEL ACARTURK 2 , NEVIN TOPAK 3 , AHMET KAHRAMAN 4 , FATMA HUSNIYE DILEK 3 , YUSUF AKCAN 2 , OZCAN KARAMAN 1 , MEHMET COLBAY 1 , and SEREF YUKSEL 1 1 Department of Internal Medicine, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey 2 Department of Internal Medicine and Gastroenterology, School of Medicine, Afyon Kocatepe University, Afyonkarahisar 03200, Turkey 3 Department of Pathology, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey 4 Department of Biochemistry, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey Background. Inflammation induces some structural and biochemical alterations and oxidative damage in gastric tissue. In this study, we aimed to investigate the rela- tionship among the severity of symptoms, oxidative stress, and grading scales of Helicobacter pylori-induced gastric inflammation in functional dyspepsia. Methods. Thirty-five patients with functional dyspepsia were enrolled in the study. The severity of dyspepsia within the last 6 months was evaluated by Glasgow Dyspepsia Severity Score. In biopsy specimens of gastric mucosa, severity of gastritis was estimated by the revised Sydney Classification System, and oxidative stress parameters were studied. Results. Although there was no statisti- cally significant relationship between symptom scores and degree of chronic inflammation, a tendency for symptoms to be more severe has been observed in low levels of gastritis. Levels of sulfhydryl groups were lower in subjects with high levels of chronic inflamma- tion, and Helicobacter pylori intensity (P < 0.001 and P = 0.02, respectively). Levels of malondialdehyde were higher in subjects with high levels of chronic inflamma- tion (P = 0.04). There was a statistically significant but a weak positive correlation between symptom scores and sulfhydryl levels (P < 0.001, r = 0.323). Conclusions. In conclusion, there may be an inverse relation between severity of symptoms and level of Helicobacter pylori- induced gastric inflammation or oxidative stress in patients with functional dyspepsia. Key words: oxidative stress, chronic gastritis, symptom scores Introduction Although the pathogenesis of functional dyspepsia remains uncertain, different pathophysiological mecha- nisms such as gastroduodenal motor dysfunction, 1–4 abnormal visceral sensory perception, 5 vagal dysfunc- tion, 6 Helicobacter pylori infection, 7 and physicosocial factors 8 have been suggested to play a role in develop- ment of functional dyspepsia. However, no structural or biochemical cause has been established to explain the symptoms. H. pylori infection is the major cause of chronic gas- tritis. Therefore, chronic gastric inflammation may have a role in the development of symptoms experienced by functional dyspepsia patients with H. pylori infection. Different investigators have shown several structural and biochemical changes that seem to be related to the inflammation of gastric tissue. The severity of inflam- mation may cause changes in the numbers of endocrine cells regulating acid secretion. 9 There may be a relation- ship between serum pepsinogen levels and severity or activity of inflammation. 10 The severity of inflammation affects proximal gastric motility, and the activity of inflammation determines the severity of duodenitis. 11,12 In experimental models, gastric inflammation has been shown to change both motility and visceral sensory perception. 13 Another change caused by H. pylori-associated inflammation is the release of free oxygen radicals by inflammatory cells. Free oxygen radicals may have a role in pathogenesis of gastritis and peptic ulcer by dam- aging the integrity of biological tissues. 14–16 However, it is unclear that mediators or oxidative stress secondary to inflammation explain symptoms in patients with functional dyspepsia. In this study, we investigated the possible relation- ships among the severity of symptoms, oxidative stress, and grading scales of gastritis caused by H. pylori infec- tion in patients with functional dyspepsia. Received: August 28, 2007 / Accepted: August 6, 2008 Reprint requests to: I. Uslan