Eradication treatment should be limited to patients with proved peptic ulceration

EDITOR—Benefits from treating Helicobacter pylori infection may depend less on the choice of eradication regimen than on the selection of patients to be treated. Rauws and van der Hulst make sound recommendations for the former at the expense of misleading on the latter.1 Their advice to general practitioners to test and prescribe eradication treatment in dyspeptic patients aged under 45 reflects that of the European Helicobacter Study Group2; neither set of recommendations is evidence based.

Both sets of recommendations advocate the safety net of specialist referral when eradication has failed in primary care. This ignores the reality that fewer than one quarter of dyspeptic patients with H pylori infection have peptic ulcer disease and that only this group of patients can be confidently expected to …