Background Helicobacter pylori may have major implications for patients’ wellbeing and future health. If a patient is found to be H. pylori positive it is important that the infection is eradicated because of the risk of associated peptic ulcers and gastric cancers. There are, however, great demands on NHS gastroenterology and endoscopy services and following the introduction of recent guidelines for dyspepsia some of these issues may be addressed. The literature suggests that a strategy of test and treat before endoscopy referral will benefit patients and be cost-effective.

Conclusion There is evidence that, over a period of time, it is more prudent to test and treat H. pylori first and then review the patient’s condition before endoscopy is performed (if no other symptoms are identified).