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The effect of Helicobacter pylori (HP) eradication on functional dyspepsia has been analysed in several clinical trials, including large, controlled and well-designed studies as well as small, flowed studies. The results of these studies indicate that HP infection does not play a major role in the aetiology of this disease and that HP eradication improves dyspeptic symptoms in no more than 15% of patients as compared to placebo. From a practical point of view 15 patients need to be treated for one to benefit while, in duodenal ulcer, 1.4 patient need to be treated for one to benefit. It remains to be elucidated if HP eradication in functional dyspepsia is useful to reduce the risk of developing organic dyspepsia (namely peptic ulcer) in functional dyspepsia. In uninvestigated dyspepsia the management of HP infection in primary care has been fully debated.Two therapeutics strategies have been proposed: test and scope and test and treat. The value of test and treat strategy over alternative strategies has been demonstrated in several decision analyses. HP test and scope increases costs in primary care without improving symptoms and saves only 15% of endoscopies.
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