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How should Helicobacter pylorinegative patients be managed?
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  1. V Stanghellini,
  2. C Tosetti,
  3. R De Giorgio,
  4. G Barbara,
  5. B Salvioli,
  6. R Corinaldesi
  1. Department of Internal Medicine and Gastroenterology, University of Bologna, Policlinico S. Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy
  1. Professor Stanghellini.

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Summary

Dyspepsia is a digestive syndrome distinct from (although frequently overlapping with) gastro-oesophageal reflux disease (GORD) and irritable bowel syndrome (IBS), which is characterised by various combinations of painful and non-painful symptoms arising from the epigastrium. Dyspepsia can be secondary to a variety of diseases, but in most instances it is idiopathic. Helicobacter pylori infection is responsible for the majority of peptic ulcers and of other diseases potentially associated with dyspepsia. Nevertheless, a causal role for H pyloriinfection in symptom occurrence has not been established. Experimental data indicate that H pylori eradication does not improve symptoms in the majority of dyspeptic patients. It has been proposed recently that H pylori negative patients should be managed according to their clinical presentation. Some reports suggest that taking into consideration the most relevant or “predominant” symptom may help to identify distinct subgroups among dyspeptic patients with different underlying pathophysiological abnormalities and different responses to treatment. Well designed and conducted prospective studies are needed to verify whether treatment of H pylorinegative dyspeptic patients based on the predominant symptom actually is a cost effective approach.

Doctors and investigators have been puzzled by dyspepsia for decades. Two factors have recently occurred to stimulate further their interest in this field: understanding of the pathogenic role played byH pylori in gastroduodenal diseases potentially associated with dyspeptic symptoms; and the squeeze on health care budgets which prompts scrutiny of diagnostic and therapeutic decisions.

Organic diseases are rare among young H pylori negative dyspeptic patients without alarm features1 and non-invasive H pylori testing has been proposed to decrease referrals for upper gastrointestinal endoscopy without significantly increasing the risk of missing dangerous diseases.2-4 Both European5 and North American guidelines6suggest that all young patients who are found to beH pylori positive by breath test or …

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