Peptic ulcer disease is a serious disorder affecting many people and carrying substantial morbidity and even mortality as a result of bleeding or perforation.1 ,2 The discovery ofHelicobacter pylori as its main aetiological factor is a major breakthrough in gastroenterology. We can cure patients that before were suffering from a chronic recurrent ailment. After curing the infection, H pyloriassociated ulcers do not recur, nor do ulcer complications.3 Quality of life improves, use of medication diminishes or stops, and the number of doctor visits, hospital admissions, and absenteeism from work decreases. Curing the infection may even increase life expectancy.2 Hence treating H pylori infection in ulcer patients is associated not only with improved health but also with significant economic benefits. It was demonstrated that the use of acid suppressants decreases significantly in ulcer patients whereas it usually does not decrease in those with non-ulcer dyspepsia.4-7

Some have claimed that reflux symptoms and/or reflux oesophagitis may develop in successfully treated patients. Whether this is a true development of a new disease or merely the unmasking of an already present but occult diathesis is controversial.8 ,9 This possible disadvantage does not outweigh the benefits of curing the infection in this specific ulcer patient group.

The major clinical discoveries regarding this infection are well known to general practitioners, internists, gastroenterologists, and microbiologists. Unfortunately, implementation of this new knowledge to the level of actually treating the right patients remains problematic. In general it is hard to change physician behaviour.10Many ulcer patients even today are still being treated with chronic or on demand acid suppressants, a therapy now considered obsolete.11 ,12 Vreeburg et alshowed that only a minority of patients admitted with an upper gastrointestinal bleed in the Amsterdam area was tested …