Helicobacter pylori and smoking: Two additive risk factors for organic dyspepsia

The hopes to distinguish between organic and functional dyspepsia on the gr ounds of the patient's symptomatology have not been fulfilled due to the lo w specificity of the so-called sinister symptoms. There is increasing evide nce accumulating that Helicobacter pylori status and other environmental fa ctors such as smoking have a higher discriminant power. Studies performed i n our laboratories testing H. pylori status on gastric biopsy samples have shown that preselection of patients according to smoking habits and H. pylo ri status has a higher potential in avoiding unnecessary endoscopies in pri mary care patients as compared to risk factors based on patient complaints. Out of a total population of 282 primary care patients, one out of 24 endo scopies revealed significant pathology such as peptic ulcer or reflux esoph agitis in the non-smokers with a negative H, pylori status, but when both r isk factors were positive, the percent age rose to one out of every two pat ients. These observation have largely been confirmed by recent studies wher e H. pylori status was prospectively assessed prior to endoscopy by highly specific H. pylori serology or C-13 breath test analysis.