Reports of strong associations in small observational studies without appropriate adjustment for potential confounding factors were not generally confirmed by larger and better- design ed studies .
The available evidence indicates that there is no strong association between H pylori and dyspepsia , but there is insufficient evidence to confirm or refute the existence of a modest association
BACKGROUND Previous studies have yielded conflicting results and substantial uncertainty about any independent association of Helicobacter pylori infection with dyspepsia , and about any benefits of antibiotic treatments for nonulcer or uninvestigated dyspepsia .
OBJECTIVES To perform a systematic review of the literature to determine whether chronic infection with H pylori is relevant to nonulcer or uninvestigated dyspepsia .
Symptomatic benefit from eradicating Helicobacter pylori infection in patients with nonulcer dyspepsia.
BACKGROUND The eradication of Helicobacter pylori infection is beneficial in patients with gastric or duodenal ulcers . The value of eradicating the infection in patients with dyspepsia and no evidence of ulcer disease is not known . METHODS We performed a r and omized , placebo-controlled trial comparing the efficacy of treatment for two weeks with 20 mg of omeprazole orally twice daily , 500 mg of amoxicillin three times daily ( with 500 mg of tetracycline three times daily substituted for amoxicillin in patients allergic to penicillin ) , and 400 mg of metronidazole three times daily ( 160 patients ) with that of omeprazole alone  ( 158 patients ) for resolving symptoms of dyspepsia in patients with H. pylori infection but no evidence of ulcer disease on upper gastrointestinal endoscopy . Symptoms were assessed with the Glasgow Dyspepsia Severity Score , with resolution of symptoms defined as a score of 0 or 1 in the preceding six months ( maximal score , 20 ) . One year later the patients were assessed to determine the frequency of the resolution of symptoms . RESULTS One month after the completion of treatment , 132 of 150 patients ( 88 percent ) in the group assigned to received omeprazole and antibiotics had a negative test for H. pylori , as compared with 7 of 152 ( 5 percent ) in the group assigned to receive omeprazole alone . One year later , dyspepsia had resolved in 33 of 154 patients ( 21 percent ) in the group given omeprazole and antibiotics , as compared with 11 of 154 ( 7 percent ) in the group given omeprazole alone ( 95 percent confidence interval for the difference , 7 to 22 percent ; P<0.001 ) . Among the patients in the group given omeprazole and antibiotics , the symptoms resolved in 26 of the 98 patients ( 27 percent ) who had had symptoms for five years or less , as compared with 7 of the 56 patients ( 12 percent ) who had had symptoms for more than five years ( P=0.03 ) . CONCLUSIONS In patients with H. pylori infection and nonulcer , or functional , dyspepsia , treatment with omeprazole and antibiotics to eradicate the infection is more likely to resolve symptoms than treatment with omeprazole alone
Reports of strong associations in small observational studies without appropriate adjustment for potential confounding factors were not generally confirmed by larger and better- design ed studies .
The available evidence indicates that there is no strong association between H pylori and dyspepsia , but there is insufficient evidence to confirm or refute the existence of a modest association
BACKGROUND Previous studies have yielded conflicting results and substantial uncertainty about any independent association of Helicobacter pylori infection with dyspepsia , and about any benefits of antibiotic treatments for nonulcer or uninvestigated dyspepsia .
OBJECTIVES To perform a systematic review of the literature to determine whether chronic infection with H pylori is relevant to nonulcer or uninvestigated dyspepsia .