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

Ronald J. Schlemper, PhD; Sjoerd D. J. van der Werf, PhD; Jan P. Vandenbroucke, PhD; Izäk Biemond, PhD; Cornelis B. H. W. Lamers, PhD
Arch Intern Med. 1995;155(20):2254-2255. doi:10.1001/archinte.1995.00430200155020.
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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


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