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In a Dutch working population, the apparent association between dyspeptic symptoms and Helicobacter pylori infection was found to be entirely due to subjects with an ulcer history. In general populations with a much higher prevalence of H. pylori infection and peptic ulcer disease, such as in Japan, the relationship between dyspepsia and H. pylori has yet to be clarified. A questionnaire on ulcer history and dyspeptic symptoms during the preceding 3 month period was obtained from apparently healthy Japanese employees who underwent a periodic medical examination. In addition, serum samples were analysed for anti-H. pylori IgG antibodies. A total of 196 men and 35 women, aged 23-71 years, participated in the study. Seven women (20%) and 49 men (25%) had a diagnosis of peptic ulcer disease. Among 41 subjects with verified duodenal (26) and/or gastric (17) ulcer, 95% were H. pylori positive while 32% had had frequent dyspeptic symptoms in the 3 months prior to the study (29% of the 35 men and 50% of the 6 women). Among the 147 men and 28 women without an ulcer history, the 3 month period prevalence of frequent dyspepsia was 14 and 32%, respectively. The rate of H. pylori positivity was 80% in non-ulcer dyspeptics and 68% in all other non-ulcer subjects (95% confidence intervals: 61-92 and 61-76%, respectively). Significant differences in symptoms between H. pylori positive and negative subjects could not be detected, neither in the whole population nor in the non-ulcer group. In conclusion, in this Japanese working population, no association was found between dyspeptic symptoms and H. pylori infection, irrespective of the inclusion of subjects with a peptic ulcer history.

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. 2 Loffeld and Werdmuller imply that we only defined a specific set of symptoms to determine whether H pylori plays a role in NUD. On the

Background: There is considerable debate about whetherHelicobacter pyloriinfection is important in causing non-ulcer dyspepsia. Many studies assessing this relationship have been performed in selected patient populations and included patients with a history of peptic ulcer. General population-based data with attention to ulcer history are needed to clarify this relationship. Methods: A questionnaire on ulcer history and dyspeptic symptoms during the preceding 3-month period was obtained from apparently healthy employees who underwent a periodic medical examination in the Netherlands. In addition, serum samples were analyzed for anti—H pyloriIgG antibodies. Results: A total of 427 men and 73 women, aged 22 to 69 years, participated in the study. None of the women but 27 men (6%) had a previous diagnosis of peptic ulcer. Among 19 unoperated-on men with verified duodenal (17 subjects) and gastric (two subjects) ulcer, 89% were H pylori positive, while 74% had frequent dyspeptic symptoms in the 3 months before the study. Among the 400 men and 73 women without an ulcer history, the 3-month period prevalence of frequent dyspepsia was 13% and 21%, respectively. The rate ofH pyloripositivity was 25% in subjects with nonulcer dyspepsia and 29% in all others. TheH pyloriinfection rate increased with age and with a lower occupational level but was independent of gender. In the male population, various differences in symptoms betweenH pylori—positive andH pylori—negative subjects could be detected when the 27 subjects with a history of ulcer were included, whereas these differences disappeared when these subjects were excluded. Conclusions: In the Dutch working population, nonulcer dyspepsia is not related toH pyloriinfection, whereas for duodenal ulcer the relationship is clear. The apparent association between dyspeptic symptoms andH pyloriinfection is entirely accounted for by subjects with an ulcer history. (Arch Intern Med. 1995;155:82-87)