Antibiotic treatment may prevent deaths in the decades ahead

Infection with Helicobacter pylori is the main cause of human gastritis,1 the major cause of peptic ulcer,2 and an important risk factor for gastric cancer.3 In 1994 the US National Institutes of Health recommended antibiotic treatment of H pylori for patients with gastroduodenal ulcers.2 This approach has been swiftly adopted4 and will surely accelerate as newer and more effective regimens are introduced. A more difficult dilemma, however, concerns the management of the growing number of dyspeptic patients who are diagnosed with confirmed H pylori infection but no ulcer.

No convincing evidence exists to suggest that eradicating H pylori improves the symptoms of non-ulcer dyspepsia,5 but as testing for the infection becomes part of the routine investigation of dyspeptic patients the question arises whether treatment should be given as an insurance against future, more serious, illness. Indeed, ethical, and perhaps legal, difficulties may confront the doctor who diagnoses a patient as H pylori positive and then fails to do anything about it. Even if serious sequelae are uncommon, is it appropriate to tell these patients that they have an infection which conveys no known benefit to them, that …