Approach to Dyspepsia According to Helicobacter Pylori Status in Iran

Helicobacter pylorus (HP) is a common infection in Iran. Inappropriate laboratory tests for its diagnosis such as serology and irrational drug prescription for HP treatment in patients with non-ulcer dyspepsia is a drastic obstacle in our country. Treating every patient with dyspepsia without peptic ulcer or precancerous lesions, not only results in high economic burden on health system, but also causes antimicrobial resistance and undesirable clinical outcomes. The Iranian Society of Gastroenterology and Hepatology discussed this topic in a meeting and suggested preparing a guideline for approach to dyspepsia in Iran. Then, the literatures were reviewed and the published data in our area were searched and a practical guideline was developed. According to the present evidences, we suggest HP treatment only for patients with peptic ulcer, infected gastric cancer patients and their first degree relatives and also for MALT lymphoma. We suggest standardized urea breath test, endoscopic biopsy or stool antigen test for diagnosis of HP infection and its eradication. Serology is not a suitable diagnostic method for evaluation of HP infection even prior to the treatment. Because of ineffectiveness, we dont suggest HP eradication treatment for non-ulcer dyspepsia.