Nonulcer Dyspepsia and Helicobacter pylori: Causal or Coincidental?-Reply

In reply  We thank Loffeld and Werdmuller for their interest in our article.¹ We took great care to find out whether Helicobacter pylori is associated in any way with nonulcer dyspepsia (NUD) by analyzing a subgroup of subjects with "essential dyspepsia." The presence of subjects with NUD from other identifiable causes might weaken a possible association with H pylori infection. Therefore, essential dyspepsia was defined as NUD in the absence of irritable bowel syndrome and regular nonsteroidal anti-inflammatory drug use, as well as in the absence of heartburn and/or acid regurgitation as the only frequent dyspeptic symptom(s). When heartburn or acid regurgitation clearly dominated a patient's complaints, these symptoms were shown to have a high specificity (85% and 96%) for gastroesophageal reflux disease.²Loffeld and Werdmuller imply that we only defined a specific set of symptoms to determine whether H pylori plays a role in NUD. On the