SUMMARY

* Dyspepsia is a range of symptoms usually involving epigastric discomfort. It is associated with a wide range of disorders, from mild gastritis and oesophageal reflux, to gastric malignancy.

* The nature and severity of symptoms are a poor guide to the underlying disorder. The first decision to be made is whether the patient's symptoms require further investigation by endoscopy.

* Resources for invasive investigation are limited, relative to the large number of patients who present with dyspepsia. Recent guidelines from the British Society of Gastroenterology provide a set of criteria which may be useful when deciding which patients to investigate.

* Helicobacter pylori is associated with peptic ulcer disease, gastritis and duodenitis and gastric neoplasia. There is strong evidence that eradication of this organism dramatically reduces the relapse rate in peptic ulcer. There are also reports of regression of low grade gastric lymphoma after eradication therapy.

* Antibiotic treatment to eradicate H. pylori is strongly recommended in cases of proven duodenal ulcer (confirmation of infection not essential), and gastric ulcer (if the patient has been shown to be infected).

* However, it is not known whether eradication of the organism benefits patients with non-ulcer dyspepsia. The relative costs, risks and benefits of eradication therapy in patients who have not been investigated by endoscopy (the majority of whom will not have a peptic ulcer) are not known.

* The currently recommended treatment regimens for eradicating H. pylori involve an anti-secretory drug or bismuth chelate, with two antibiotics. Dual regimens are not recommended.