Epidemiology of dyspepsia: discriminant value of smoking and Helicobacter pylori status as predictors of peptic lesions in primary care.

Male gender and smoking have an established discriminant value of increased risk for duodenal ulcers. The present analysis is focused on whether this could be generally enhanced by considering Helicobacter pylori status in dyspeptic patients consulting their primary physician. Patients were enrolled into our Dyspepsia Study if they met the following criteria: Symptoms for minimum one month, informed consent for drug trial, including upper gastrointestinal endoscopy (UGE), if required. All were prospectively screened for criteria suggesting an organic origin of the disorder such as nocturnal pain, severe pain, severe regurgitation or heartburn, loss of weight, pain relieved by food, age > 50 years. 16% of patients had one or more relevant lesion: 7.8% oesophagitis, 8.5% duodenal ulcers, and 1.8% gastric ulcers. Of the clinical criteria enumerated only nocturnal pain and/or severe regurgitation or heartburn had a marginal discriminant power (P < 0.1). In contrast smoking and/or positive CLO-urease test had a substantial and significant (P < 0.001), discriminant value both for oesophagitis and duodenal ulcers. Patients with both a positive CLO-urease test and who smoked accounted for only 16% of the population but for 46% of the lesions, but this was only 4% for the 42% subjects who were non-smokers and had a negative CLO-urease test. Positive H. pylori status and smoking appear to have an important and probably additive discriminant value to distinguish between organic and functional dyspepsia.