Should we eradicate Helicobacter pylori in non-ulcer dyspepsia?

EPIDEMIOLOGICAL STUDIES Forty two epidemiological studies compared the prevalence of H pylori infection in dyspeptic patients and asymptomatic controls (see website fig 1). Meaningful studies should use the following design: an appropriate definition of dyspepsia; adequate sample size; dyspeptic subjects and controls sampled from the general population; and results adjusted for potential confounders such as age, sex, smoking, ethnicity, and socioeconomic status. Of 20 endoscopic studies, only two were population based and used adequate controls matched at least for age and sex (see website fig 1A). 2 The prevalence of H pylori infection in NUD subjects and in asymptomatic controls was similar in one study. The results of the other study were probably biased as the positive association between H pylori infection and dyspeptic symptoms was obtained by subgroup analysis. Of 22 studies which used non-invasive tests to determine H pylori status, five well performed studies were identified (see website fig 1B). Three studies found no association between H pylori infection and dyspeptic symptoms. 6 7 In two studies, the prevalence of H pylori infection was higher in dyspeptic subjects than in asymptomatic controls. 5 However, the diVerence was small (7–8%) and peptic ulcer was not excluded by endoscopy. Thus it is likely that the diVerence would be smaller or even absent had the patients undergone endoscopy.