| Sumario: | Objective: To identify which Helicobacter pylori-positive dyspeptic patients have an increased likelihood of having peptic ulcer and may thus be more likely to benefit from empirical H. pylori eradication therapy.Methods: 622 out of 740 consecutive dyspeptic subjects (median age 45 years, range 14-91, 51% male) attending for rapid access endoscopy were eligible for the study. Demographic data and endoscopic findings were recorded. H. pylori status was determined by urease and histology.Results: In all age groups, peptic ulcers were commoner in males than females [44% (85/195) vs 23% (32/139), P < 0.001] and in smokers than non-smokers [47% (46/97) vs 32% (50/159), P < 0.05]. Males, heavy smokers and those with a family history of peptic ulcer had increased adjusted odds of having a peptic ulcer (2.59, 1.96 and 1.90, respectively). Corresponding odds ratios for those aged under 45 were 2.59, 0.94 and 2.52. In H. pylori-positive dyspepsia, being a male who either smoked heavily or had a family history of peptic ulcer gave a sensitivity and positive predictive value for peptic ulcer of 86 and 45% for all age groups and 85 and 49% for those aged under 45.Conclusion: Male H. pylori dyspeptics who smoke >10 cigarettes per day and/or have a family history of peptic ulcer are likely to have peptic ulcer and are thus likely to benefit from empirical eradication therapy.
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