Non-ulcer dyspepsia (NUD) is a term used when patients have symptoms thought to be arising from the upper gastrointestinal tract but investigations, including endoscopy, show no clear underlying cause. It is a very common condition and one for which there is no particularly effective treatment.

The aetiology of NUD is largely unknown and presumed to be heterogeneous. The prevalence of H pylori infection is slightly higher in NUD patients than in asymptomatic controls,1 ,2 raising the possibility of the infection being the cause of symptoms in a subgroup of such patients.

Several well designed studies have now examined the effect ofH pylorieradication therapy versus placebo on symptom resolution inH pylori positive patients with NUD. Some of these studies have shown a clear statistically significant benefit of active treatment3-6while others have shown no significant difference.7-10Symptomatic benefit has been most apparent in the studies conducted in single centres or within a single country and least apparent in multicentre multinational studies. Symptomatic response is a difficult outcome to assess and reliable measurement is likely to be …