Which Helicobacter pylori-positive dyspeptics are likely to respond symptomatically to empirical H. pylori eradication?

To identify which Helicobacter pylori-positive dyspeptic patients have an increased likelihood of having peptic ulcer and may thus be more likely to benefit from empirical H. pylori eradication therapy.

622 out of 740 consecutive dyspeptic subjects (median age 45 years, range 14-91, 51% male) attending for rapid access endoscopy were eligible for the study. Demographic data and endoscopic findings were recorded. H. pylori status was determined by urease and histology.

In all age groups, peptic ulcers were commoner in males than females [44% (85/195) vs 23% (32/139), P < 0.001] and in smokers than non-smokers [47% (46/97) vs 32% (50/159), P < 0.05]. Males, heavy smokers and those with a family history of peptic ulcer had increased adjusted odds of having a peptic ulcer (2.59, 1.96 and 1.90, respectively). Corresponding odds ratios for those aged under 45 were 2.59, 0.94 and 2.52. In H. pylori-positive dyspepsia, being a male who either smoked heavily or had a family history of peptic ulcer gave a sensitivity and positive predictive value for peptic ulcer of 86 and 45% for all age groups and 85 and 49% for those aged under 45.

Male H. pylori dyspeptics who smoke >10 cigarettes per day and/or have a family history of peptic ulcer are likely to have peptic ulcer and are thus likely to benefit from empirical eradication therapy.