Usefulness of the script concordance test in dermatology.

BACKGROUND: The script concordance test (SCT) measures clinical data interpretation in the context of uncertainty. To our knowledge, its feasibility has not yet been demonstrated in dermatology. OBJECTIVES: This study describes the feasibility, reliability and validity of the SCT for use in dermatology teaching to family medicine residents. METHODS: We designed an SCT for dermatology teaching, adapted to the level of family medicine students. The family medicine residents attending a dermatology lecture course and a reference panel of dermatologists underwent the test. Software available on the SCT-dedicated website was used to determine the scores. The Cronbach's α was calculated. The scores were described by means, standard deviation, and minimum and maximum scores. Mann-Whitney tests were used to compare resident and reference panel scores. RESULTS: The test contained 33 vignettes of four questions each. Cronbach's α was 0.80. Mean scores were 75.6 for the reference panel and 65.0 for the residents (P = 0.0009). CONCLUSIONS: This study confirmed the SCT's capacity to distinguish groups on the basis of experience. This study demonstrated the feasibility and reliability of the SCT in the field of dermatology.

[Helicobacter pylori: When to look for an infection and treat it in adults?] / Helicobacter pylori : quand rechercher une infection et la traiter chez l'adulte ?

Helicobacter pylori infection is acquired during childhood mainly within the family. It causes active chronic gastritis associated with the development of many digestive and extra digestive diseases. Its expression results from interactions between the bacteria, the host and environmental factors modulating the evolution of gastritis and acid secretion. The French recommendations for research and treatment for curative or preventive purposes were updated in 2017. These are indications with a high level of evidence for association and efficacy of the eradication treatment: peptic ulcer, taking non-steroidal anti-inflammatory drugs or aspirin with an ulcer history, gastric MALT lymphoma, and localized resection of gastric cancer. The recommendations relate to other diseases with a lower level of evidence: functional dyspepsia, risk factors for gastric adenocarcinoma (family history of gastric cancer, Lynch syndrome, pre-neoplastic lesions: atrophy, intestinal metaplasia, dysplasia), unexplained iron deficiency anemia and vitamin B12 deficiency, immunological thrombocytopenic purpura, bariatric surgery isolating part of the stomach. The diagnosis is made by examining gastric biopsies or by non-invasive test depending on the clinical situation. The 10-day triple therapies guided by the study of antibiotic sensitivity (proton pump inhibitors (PPI), amoxicillin, clarithromycin or levofloxacin) are recommended as first-line treatment because of the increase in resistance, allowing the reduction of the duration of treatment, the number of antibiotics and side effects. By default, probabilistic quadruple therapies of 14 days are possible and interchangeable (PPI with amoxicillin, clarithromycin, metronidazole, or a combination of bismuth salt, tetracycline and metronidazole). Eradication control is necessary.

[The practice of telemedicine by French internal medicine physicians in 2019]. / La pratique de la télémédecine par les médecins internistes français en 2019.

INTRODUCTION: Telemedicine has been developing in France since 2018. The objective of this survey was to assess the knowledge, attitudes, practices and training of internal physicians regarding telemedicine. MATERIAL AND METHODS: A national descriptive observational study carried out between July and October 2019, via an online self-questionnaire with members of the National Society of Internal Medicine and the Association of Young Internists, included a descriptive and comparative analysis by subgroups of age. RESULTS: Analysis of 309 responses from physicians qualified in internal medicine or practicing in an internal medicine service (61,8%) and residents in internal medicine (38%) showed that 34.6% had notions or a good knowledge of regulation of telemedicine. For 62,1%, 72.5% and 74.1% respectively, it could improve patient care, access to care and exchanges between internists and other doctors. The main obstacles to this practice were the absence of face-to-face with the patient (57.3%) and computer dysfunctions (55%). Only 23.3% practiced it, including 88.9% tele-expertise. Telemedicine was performed informally (telephone and email) in 70.8% of the cases. Doctors over the age of 50 were better acquainted with the regulations and more practiced official telemedicine. In total, 54% wanted to practice telemedicine and 72.8% wanted to train there. CONCLUSION: Attitudes towards telemedicine were positive, but few internists knew about it and practiced it formally, warranting appropriate training.

[Chronic fatigue syndrome: A new disorder?] / Le syndrome de fatigue chronique : une nouvelle maladie ?

More than 30 years after its individualization, chronic fatigue syndrome (CFS) remains a debilitating condition for the patient and a confusing one to the physicians, both because of diagnostic difficulties and poorly codified management. Despite the numerous work carried out, its pathophysiology remains unclear, but a multifactorial origin is suggested with triggering (infections) and maintenance (psychological) factors as well as the persistence of inflammatory (low grade inflammation, microglial activation…), immunologic (decrease of NK cells, abnormal cytokine production, reactivity to a variety of allergens, role of estrogens…) and muscular (mitochondrial dysfunction and failure of bioenergetic performance) abnormalities at the origin of multiple dysfunctions (endocrine, neuromuscular, cardiovascular, digestive…). The complexity of the problem and the sometimes contradictory results of available studies performed so far are at the origin of different pathophysiological and diagnostic concepts. Based on a rigorous analysis of scientific data, the new American concept of Systemic Disease Exertion Intolerance proposed in 2015 simplifies the diagnostic approach and breaks with the past and terminologies (CFS and myalgic encephalomyelitis). It is still too early to distinguish a new disease, but this initiative is a strong signal to intensify the recognition and management of patients with CFS and stimulate research.

Second-line treatment for failure to eradicate Helicobacter pylori: a randomized trial comparing four treatment strategies.

AIM: To compare the efficacy of different regimens in patients in whom previous Helicobacter pylori eradication therapy has failed. METHODS: In this study named StratHegy patients (n=287) were randomized to receive one of three empirical triple therapy regimens or a strategy based on antibiotic susceptibility. The empirical regimens were omeprazole, 20 mg b.d., plus amoxicillin, 1000 mg b.d., and clarithromycin, 500 mg b.d., for 7 days (OAC7), clarithromycin, 500 mg b.d., for 14 days (OAC14) or metronidazole, 500 mg b.d., for 14 days (OAM14). In the susceptibility-based strategy, patients with clarithromycin-susceptible strains received OAC14, whilst the others received OAM14. The 13C-urea breath test was performed before randomization and 4-5 weeks after eradication therapy. RESULTS: In the intention-to-treat analysis, the eradication rates for empirical therapies were as follows: OAC7, 47.4% (27/57); OAC14, 34.5% (20/58); OAM14, 63.2% (36/57); it was 74.3% (84/113) for the susceptibility-based treatment (P<0.01 when compared with OAC7 and OAC14). In patients receiving clarithromycin, the eradication rates were 80% for clarithromycin-susceptible strains and 16% for clarithromycin-resistant strains; in patients receiving OAM14, the eradication rates were 81% for metronidazole-susceptible strains and 59% for metronidazole-resistant strains. CONCLUSIONS: Eradication rates of approximately 75% can be achieved with second-line triple therapy based on antibiotic susceptibility testing. If susceptibility testing is not available, OAM14 is an appropriate alternative.

IgA nephropathy and alcoholic liver cirrhosis. A prospective necropsy study.

The incidence of mesangial IgA nephropathy (mIgAN) was investigated in a series of patients with alcoholic liver cirrhosis (ALC). Biologic parameters classically reported in IgAN were assessed in 98 patients, namely hematuria, proteinuria, and serum IgA. An immunohistologic study of the liver and kidney was performed in 33 patients who died during the study. Renal data were compared with those obtained in a matched necropsic series of controls. This study confirmed a global elevation of serum IgA levels in ALC. A possible hepatic origin of these immunoglobulins was supported by the observation of plasma cells in portal spaces in 68% of the patients. Biologic signs of renal disease consistent with mIgAN were observed in 16% of the patients; IgAN was diagnosed in 18% of patients with ALC and 10% of the controls. These data suggest that the incidence of mIgAN in ALC is not different than in the general population.

Gastric diffusion of antibiotics used against Helicobacter pylori.

Only a few pharmacological studies have been carried out on men and guinea pigs to determine the gastric diffusion of antibiotics, which are active against Helicobacter pylori. The results of these studies have been analysed in considering the physicochemical nature, the mode of administration, the way of gastric diffusion (topic and/or systemic) and the pharmacological interactions. The correlation of these pharmacokinetic results with those obtained in clinical trials is difficult because of the heterogeneity of the pharmacological and pharmacodynamic data. The absence of a convenient and suitable animal or in vitro study model renders further standardized pharmacokinetic studies in infected man and at steady state necessary.

Isotype evolution in the follow-up study of patients with Campylobacter pylori associated gastritis.

Four sequential immuno-assays were performed from May to November 1988 to follow the levels of IgG, IgA and IgM to Campylobacter pylori in 16 infected patients with histologically proven gastritis, among which 12 received appropriate therapy. Histopathological examination of antral biopsies, bacteriological cultures and urease tests were performed on each occasion when serum was tested for antibodies to C. pylori. The detection and quantitative assessment of the various isotypes to this bacterium proved valuable to appreciate the response to therapy with, in case of success, a steady decrease of antibodies levels concomitant with clinical improvement.

[Scanning electron microscopic study of Campylobacter pylori and associated gastroduodenal lesions]. / Etude en microscopie électronique à balayage de Campylobacter pylori et des lésions gastroduodénales associées.

The detection of Campylobacter pylori was carried out with scanning electron microscopy (SEM) on 4,590 biopsies taken from 1,714 adult patients (1,348 duodenal biopsies, 1,690 antral biopsies and 1,552 fundic biopsies). The mucus was removed and the fragments of mucosa were then fixed with glutaraldehyde, dehydrated, critical point-dried with CO2 or hexamethyldisilazane, mounted, coated with gold, and observed with SEM. Under SEM, C. pylori was characterized by its spiral-shape (long form 2.5 to 6 microns) or by its curved-shape (short form 1.5 microns) and by its relatively constant diameter (0.5 micron). C. pylori was present in 671 patients (40 p. 100) and was found mainly in the fundus and antrum, near the neck of the gastric glands and at the level of the intracellular spaces. It was never present on the surface of enterocytes but was found in the 26 duodenal biopsies in the gastric metaplasia areas and on the surface of adjacent muciparous cells. The main epithelial lesions associated with C. pylori were of an erosive or desquamative type. The high definition observed using SEM allowed C. pylori to be distinguished from other microorganisms observed on the surface of the gastroduodenal mucosa: bacilli and cocci contaminants, Candida albicans, Giardia lamblia, spirochetes and other Campylobacters. SEM is a specific and rapid technique (less than 2 hours) which determines the morphology, localisation of bacteria as well as the associated lesions of the mucous cells.

[Comparative study of four commercialized serologic methods for the diagnosis of gastric Helicobacter pylori infection]. / Etude comparative de quatre méthodes sérologiques commercialisées pour le diagnostic de l'infection gastrique à Helicobacter pylori.

OBJECTIVE: Four commercially available enzyme-linked immunosorbent assays (ELISA) were evaluated for serological diagnosis of Helicobacter pylori (H. pylori) infection in 79 untreated patients. METHODS: Infection has been diagnosed in 40 patients, in whom culture and/or urease test and histopathology from antral biopsies, were positive for H. pylori. RESULTS: Sensitivity (Se) and specificity (Sp) of these tests, calculated with indeterminate serological results (9 patients) classified as positive (ind +) or negative (ind -), were not statistically different: GAP-test (Bio-Rad), Se = 95% (ind +), 90% (ind -), Sp = 84.6% (ind +), 89.7% (ind -); Pylori-Stat (Biowhittaker), Se = 97.5% (ind + or -), Sp = 71.8% (ind +), 71.9% (ind -); Premier H. pylori (Biomedical Diagnostics), Se = 92.5% (ind +), 90% (ind -), Sp = 84.6% (ind +), 81.2% (ind -); Cobas-Core (Roche), Se = 92.5% (ind + or -), Sp = 76.9% (ind +), 79.5% (ind -). There was a strong correlation between mucosal inflammation and H. pylori status. Discrepancies between infectious status and at least one serology result were observed in 16 patients (11 H. pylori negative and 5 H. pylori positive patients). CONCLUSION: These 4 tests are of equivalent diagnostic value. Thus, the selection of one of them should take into account cost and practicability.

Antibiotic versus maintenance therapy in the prevention of duodenal ulcer recurrence. Results of a multicentric double-blind randomized trial.

OBJECTIVES: Reduction of gastric acid secretion by maintenance therapy and eradication of Helicobacter pylori by antibiotic treatment have been shown to reduce duodenal ulcer relapse. This study compared the effect of two regimens, a 6-month maintenance on an H2 receptor antagonist versus a one-week antibiotic therapy, on the rate of duodenal ulcer relapse in duodenal ulcer patients with gastric H. pylori infection. METHODS: We conducted a 30-week, double-blind, double-dummy, multicentric clinical trial involving 119 patients (97 M, 22 F, mean age 39 +/- 14 years) randomly assigned to a daily dose of 40 mg famotidine for 6 weeks supplemented with, during the first week, either antibiotics (500 mg amoxicillin q.i.d. and 500 mg tinidazole t.i.d.-antibiotic group) or their placebo (maintenance group). Healed patients after 6 weeks entered the 6-month maintenance phase: the maintenance group received 20 mg famotidine at bedtime and the antibiotic group, a placebo. Endoscopy with antral biopsies was performed to allow a rapid urease test, culture and histological examination upon entry, after 6 weeks, 3 months, and 6 months and, whenever symptoms recurred. H. pylori status was regarded as positive if any one of these three tests was positive, and negative if all tests were negative. RESULTS: The 2 treatment groups were well balanced for all baseline characteristics. After 6 weeks, H. pylori was eradicated in 25 (45%) patients in the antibiotic group, and in 1 (2%) in the maintenance group (P < 0.01). In term of intention-to-treat, there was no significant difference in the healing rate after 6 weeks (93 and 83% in the antibiotic and maintenance groups, respectively; P = 0.15) or in the relapse rate after 6 months (13 and 28% in the antibiotic and maintenance groups, respectively; P = 0.17 Log-rank test). However, the overall failure rate (absence of healing, relapse) was lower (P = 0.04, Log-rank test) in the antibiotic group in which all relapses but one were observed in H. pylori positive patients. The rate of ulcer relapse (1/20) in patients of antibiotic group who remained free of H. pylori during the study, was significantly (P < 0.01) lower compared with that of H. pylori positive patients in the maintenance group (11/44). During the first 6-week period, more side effects were observed in the antibiotic group than in the maintenance group (4 vs 1 patient, respectively). CONCLUSIONS: Our results indicate no significant difference between ulcer relapse rates after 6 months following a one-week antibiotic therapy or long-term maintenance therapy. Short-term antibiotic therapy should be considered as a valuable alternative to the long-term maintenance therapy.

[Helicobacter pylori infection and antimicrobial agents resistance]. / Infection à Helicobacter pylori et résistance aux antibiotiques.

PURPOSE: Seven days triple therapies combining a proton pump inhibitor (PPI) and 2 antimicrobial agents (clarithromycin [C], amoxicillin [A], metronidazole [M]), are recommended for the treatment of Helicobacter pylori infection. The eradication failures have increased these last years, particularly in France (about 30%). They are essentially related to the development of antimicrobial agents resistance, mainly concerning macrolides and nitro-imidazoles. CURRENT KNOWLEDGE AND KEY POINTS: Primary resistance to clarithromycin is variable, but reaching now about 10% throughout the world and about 20% in France. It reduces the eradication success rate at 25%. The secondary resistance is very high, contra-indicating the use of clarithromycin in second line regimens. Primary resistance to amoxicillin has recently appeared, but remains very low until now, less than 2%, as the tetracyclin (T) resistance. Primary resistance to metronidazole is 3 times higher than macrolides resistance, but its determination is less accurate. Metronidazole resistance reduces eradication rate of about 25%, leading to the use of metronidazole in second line therapy, in increasing the triple therapy duration at 14 days (PPI-A-M), or in combination with quadruple therapy (Bismuth-PPI-T-M). Other rescue-treatments are efficacious, based on ranitidine bismuth citrate combined regimens or on rifabutine (R) based regimens (PPI-A-R). FUTURE PROSPECTS AND PROJECTS: The recent knowledge of the mutations mainly responsible for H. pylori resistance to antimicrobial agents now allows the development of detection methods based on the study of bacterial DNA. These methods have been validated for clarithromycin and should favour in the near future the determination of resistance by the use of biopsy culture or directly on the gastric biopsy.

[Nailbed capillaroscopy in Crohn's disease]. / Capillaroscopie au lit de l'ongle dans la maladie de Crohn.

It has recently been suggested that chronic mesenteric vasculitis was a pathogenetic mechanism in Crohn's disease. We have performed a prospective nailfold capillaroscopy study in seven patients with acute Crohn's disease. Minor nailbed abnormalities were frequently observed and three patients presented with major capillary dystrophy. These features are similar to those observed in some systemic vasculitis.

[Ki-1 positive non-Hodgkin's lymphoma disclosed by mucocutaneous ulcerations and glomerulonephritis]. / Lymphome non hodgkinien Ki-1 positif révélé par des ulcérations cutanéomuqueuses et une glomérulonéphrite.

Malignant lymphoma particularly of T phenotype can be associated with specific or non specific cutaneous lesions. These cutaneous manifestations can occur at the onset of the disease being sometimes the revealing sign or they can appear during the course of the lymphoreticular malignancies. Glomerulonephritis was also described in lymphoma. Ki-1 positive large cell lymphoma was recently identified. A new case is reported with lymphadenopathy and intestinal localisation revealed by cutaneous and mucosal ulcerations principally in the mouth and a focal segmental glomerulonephritis with endo- and extracapillary proliferation. The absence of lymphoma in cutaneous and renal lesions and the clinical presentation support the hypothesis of paraneoplastic manifestations, may be related to a vasculitis.

[Implication of emergency departments in the regulation of public hospitalizations]. / Place des services d'urgences dans la régulation des hospitalisations publiques.

PURPOSE: Emergency departments become a useful way to access to hospital care. Since these last years difficulties of hospitalization, mainly of the elderly, after visit to the emergency department, are on the increase. CURRENT KNOWLEDGE AND KEY POINTS: Emergency departments are an important mode of recruitment for hospital units, 4 patients to 10 are hospitalized from emergency departments. The difficulties of hospitalization starting at the emergency department are more important for the elderly. Actually, there are 2 type of hospital care, planed and non planed care. The development of observation units specific to the emergency departments allowed to resolve some of these difficulties. But they are limited by their small number of beds and the duration of hospitalization below to 36 h. Some hospitals developed polyvalent emergency short stay unit to hospitalize patients who visited emergency department without necessity to give them a specialized care. FUTURE PROSPECTS AND PROJECTS: This situation must allow us to purpose a better regulation of hospitalizations which includes emergency departments in a network system including the different hospital ways of taking care. A downstream way of care adapted to the emergency hospitalizations would be developed. This could include the emergency department, the observation unit and the emergency short stay unit in interface with internal medicine and general medicine units, geriatric unit and specialized units, all of them will be included in a town-hospital care network.

[Eradication of Helicobacter pylori. Is it necessary to eradicate Helicobacter pylori in gastric reflux?]. / Eradication d'Helicobacter pylori. Faut-il éradiquer Helicobacter pylori en cas de pathologie de reflux?

POTENTIAL PROTECTIVE EFFECT OF H. PYLORI: Epidemiological studies have not demonstrated an association between H. pylori infection and symptoms of gastroesophageal reflux, reflux esophagitis, or Barrett's esophagus with or without dysplasia or esophageal adenocarcinoma. On the contrary, an apparently favorable negative association has been identified suggested a potential protective effect of H. pylori. An inverse association is also observed between the severity of reflux complications and infection by strains of H. pylori expressing certain virulence markers (cogA) associated with the more severe gastric lesions. The prevalence of gastroesophageal reflux-related disease has increased steadily for more than fifty years while the incidence of H. pylori infection has decreased in developed countries. This observation might suggest that H. pylori infection plays a protective role. In addition, eradication of H. pylori could favor he development of gastroesophageal reflux or reflux esophagitis. The degree of risk is unknown. Pangastritis with significant lesions of the gastric body leading to a reversible decrease in the secretion of acid after H. pylori eradication might lower the risk of gastroesophageal reflux. POTENTIAL PROMOTION EFFECT: The relations between H. pylori and gastroesophageal reflux are complex. Reflux associated with duodenal ulcer appears to be improved by eradication of H. pylori suggesting that infection might promote the development of reflux. The causal mechanism would be increased acid secretion induced by antral gastritis predominantly resulting from the H. pylori infection. Further work is needed to determine the exact role of gastritis and perturbed acid secretion. PERSPECTIVES: Data on the role of H. pylori in transient relaxation of the lower esophageal sphincter, implicated in the pathogenesis of gastroesophageal reflux, are lacking. Antisecretion treatments reduce the quantity of gastric acid favoring H. pylori colonization of the fundic mucosa and possibly aggravating fundic gastritis. The risk of progression from H. pylori gastritis to atrophy or intestinal metaplasia of the fundus under prolonged proton pump inhibitor treatment remains to be determined. Eradication of H. pylori reduces the efficacy of antisecretory drugs according to poorly understood mechanisms. The potential effect of gastroesophageal reflux on the transmission of H. pylori infection remains to be established. PRACTICAL ATTITUDE: Much remains to be learned concerning the beneficial or deleterious effects of eradication of H. pylori on the course of gastroesophageal reflux. In clinical practice, eradication of H. pylori is not useful for patients with gastroesophageal reflux.

[The treatment of Helicobacter pylori infection]. / Le traitement de l'infection par Helicobacter pylori.

H. pylori causes inflammatory lesions of the stomach and duodenum. At the present time eradication is essentially recommended in case of gastric or duodenal ulcer. The choice of the appropriate drug depends on the characteristics of the H. pylori infection, the localization deep in the gastric mucosa, the physico-chemical properties of the gastric medium, especially the acidity which deactivates antibiotics, slow bacterial growth and the germ's sensitivity to antibiotics. Anti-infectious treatment is now based on a three-drug regimen combining an antisecretory drug (proton pump inhibitor or H2 receptor antagonist) and two antibiotics: clarithromycin associated with amoxicillin or an imidazol derivative (metronidazol or tinidazol) or tetracycline. Two antibiotics (clarithromycin, amoxicillin) as well as three anti-secretory agents (lansoprazole, omeprazole, ranitidine) have been authorized in France for three-drug regimens of 1 or 2 weeks leading to approximately 90% eradication. Special attention should be placed on the risk of resistance to antibiotics (macrolids and imidazol derivatives) and patient compliance required for successful eradication of H. pylori. Other therapeutic schemes are under assessment and a vaccine is being prepared. Eradication of H. pylori has totally changed the treatment of gastric and duodenal ulcers, eliminating the need for long-term treatment and avoiding complications.

[Helicobacter pylori gastritis: a new infectious disease. Reflections from a personal experience]. / La gastrite à Helicobacter pylori: une nouvelle maladie infectieuse. Réflexions à partir d'une expérience personnelle.

To determine the relationship of microscopic chronic antral gastritis to Helicobacter pylori, 69 consecutive patients were studied. In a prospective longitudinal study, at least 2 successive gastroscopies with antral biopsies were performed (177 investigations on the whole). Sixty six of the 69 patients were treated with various therapeutic regimens i.e. antiulcer drugs and/or antibiotics. The type and intensity of inflammation (as based on whole inflammatory infiltrate density, polymorphonuclear cells presence or absence and IgA and IgM plasma cells counts) were correlated with H. pylori status (Giemsa staining and/or biopsy culture). The presence of the organism (Hp) and the gastritis were significantly correlated (high grade of whole inflammatory infiltrate Hp + ve: 98/109 90%, Hp-ve: 9/61 15%, p less than 0.001--presence of neutrophil PMNC Hp + ve: 80/109 73%, Hp-ve: 1/61 2%; p less than 0.001--IgA and IgM plasma cells respectively Hp + ve: 7.6 +/- 6.6, 10.6 +/- 7.1, Hp-ve 1.9 +/- 2.9, 4.2 +/- 4.5; p less than 0.005). Clearance and/or eradication of H. pylori after antibiotic treatment were associated with the disappearance of chronic gastritis activity and a statistically significant decrease of whole inflammatory infiltrate density (p less than 0.001) and IgA (p less than 0.005) and IgM (p less than 0.01) plasma cells counts. Mucosal inflammation was unchanged in case of H. pylori persistence and inflammation worsening occurred in case of infection relapse. H. pylori gastric mucosa colonization seemed to be responsible for the antral chronic inflammation associated with its presence.(ABSTRACT TRUNCATED AT 250 WORDS)

[Gastritis, dyspepsia and Helicobacter pylori]. / Gastrite, dyspepsie et Helicobacter pylori.

Helicobacter pylori is a major culprit in chronic gastritis. Interactions between the infected host, the bacteria and the environment, influence the type of gastritis and the occurrence of specific diseases (peptic ulcer, gastric lymphoma and adenocarcinoma) associated with the infection in a minority of cases. The benefit of H. pylori eradication is not proved in isolated gastritis, except for rare forms such as hypertrophic or lymphocytic gastritis. In spite of a high prevalence in functional dyspepsia with normal gastroduodenal endoscopy, H. pylori is not the main cause of symptoms in dyspeptic patients, but the gastritis could be involved in the appearance of ulcer-like symptoms. Strategies for non-invasive H. pylori detection for primary eradication are developed to reduce the endoscopy workload in the management of uninvestigated dyspepsia.