How should Helicobacter pylori negative patients be managed?

Dyspepsia is a digestive syndrome distinct from (although frequently overla pping with) gastrooesophageal reflux disease (GORD) and irritable bowel syn drome (IBS), which is characterised by various combinations of painful and non-painful symptoms arising from the epigastrium. Dyspepsia can be seconda ry to a variety of diseases, but in most instances it is idiopathic. Helico bacter pylori infection is responsible for the majority of peptic ulcers an d of other diseases potentially associated with dyspepsia. Nevertheless, a causal role for H pylori infection in symptom occurrence has not been estab lished. Experimental data indicate that H pylori eradication does not impro ve symptoms in the majority of dyspeptic patients. It has been proposed rec ently that H pylori negative patients should be managed according to their clinical presentation. Some reports suggest that taking into consideration the most relevant or "predominant" symptom may help to identify distinct su bgroups among dyspeptic patients with different underlying pathophysiologic al abnormalities and different responses to treatment. Well designed and co nducted prospective studies are needed to verify whether treatment of H pyl ori negative dyspeptic patients based on the predominant symptom actually i s a cost effective approach.