Review article: tackling the "dyspeptic problem".

Dyspepsia, and the issue of Helicobacter pylori status, can present significant controversies in clinical management. Both primary physicians and gastroenterologists should be aware of options for the treatment of patients with dyspepsia. This article reviews information gathered about the eradication of H. pylori in non-ulcer dyspepsia (NUD), therapy for NUD not associated with H. pylori, and whether H. pylori testing should replace routine endoscopy in uncomplicated dyspepsia. The benefits of eradicating H. pylori in NUD include superior, cost-effective resolution of symptoms, compared to placebo; reduction of ulcer and gastric cancer risk; and removal of risk of certain adverse effects should long-term proton pump inhibitor therapy become necessary. In patients with normal endoscopy and no evidence of H. pylori, proton pump inhibitor therapy is superior to placebo in controlling symptoms. This benefit is confined to patients with symptoms and/or oesophageal pH-metry indicative of GORD. Non-invasive H. pylori testing may be appropriate for younger dyspeptic patients with no alarm symptoms who are not taking non-steroidal anti-inflammatory drugs (NSAIDs). In conclusion, eradication of H. pylori is advisable in patients with NUD. Proton pump inhibitor therapy is superior to placebo in NUD patients without H. pylori, especially if symptoms indicate GORD. H. pylori testing may replace endoscopy in young dyspeptics with no alarm symptoms or NSAID use.