Routine treatment will lead to extra workload

Editor—The editorial by Anthony Axon and David Forman contains many unwarranted assumptions.1 They suggest that doctors face ethical and perhaps legal difficulties if they fail to diagnose and treat Helicobacter pylori gastroduodenitis routinely in dyspeptic patients. This ignores the observation that H pylori gastroduodenitis is only slightly more common in people with dyspepsia than healthy volunteers2 and that only a minority of patients with non-ulcer dyspepsia derive symptomatic benefit from eradication of H pylori. For these reasons the British Society of Gastroenterology's dyspepsia management guidelines do not recommend eradication unless there is proved infection in association with erosive gastritis, peptic ulcer, or lymphoma.

Axon and Forman estimate that H pylori infection causes 8000 deaths a year in England and Wales, most from gastric cancer. The relation between …