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Multiple studies and systematic reviews have suggested that testing for and treating Helicobacter pylori infection is the most cost-effective approach for managing patients with persistent dyspepsia (Journal Watch Gastroenterology Sep 13 2005). However, whether patients within a given population will benefit from this strategy versus another depends on the prevalence of H. pylori infection in the population, the method of testing for H. pylori infection, the definition of dyspepsia used, and the timing of the decision to pursue a test-and-treat strategy. Recent guidelines from the National Institute for Health and Clinical Excellence suggest that empirical acid reduction with a proton-pump inhibitor (PPI) might also be an appropriate first-…