Does not increase symptoms of gastro-oesophageal reflux disease

Does eradication of Helicobacter pylori lead to an increase in symptoms of gastro-oesophageal reflux disease? We need to know this because the benefits of eradicating H pylori relative to acid suppression alone are small in non-ulcer dyspepsia and uninvestigated dyspepsia.1 2 The absolute benefits are 6-7%, and even a small increase in gastro-oesophageal reflux disease would be likely to make eradicating H pylori in these patients of dubious benefit. New guidelines for the management of dyspepsia in Scotland and forthcoming guidelines in England and Wales recommend eradicating H pylori in both non-ulcer dyspepsia and uninvestigated dyspepsia.3 4 In addition, advocates of population screening for and treating H pylori to prevent distal gastric cancer need to ensure that the risk-benefit ratio is favourable.

The trial reported by Harvey et al in this issue does not …