Approximately 50% of patients with nonulcer dyspepsia harbor Helicobacter pylori gastritis, yet there is no convincing evidence that H. pylori is causally linked to chronic dyspepsia. The prevalence of H. pylori is probably not higher in patients with nonulcer dyspepsia than in the asymptomatic general population, and H. pylori is not associated with a specific symptom profile. Moreover, no plausible mechanisms to explain how histologic gastritis could induce intermittent symptoms have been identified. Finally, there is a lack of cogent experimental evidence linking H. pylori to nonulcer dyspepsia. On the basis of the available data, it must be concluded that H. pylori is unlikely to play an important role in most patients with nonulcer dyspepsia.