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SUMMARY Fifty consecutive patients with non-ulcer dyspepsia and a Campylobacter associated gastritis (CAG) were randomly assigned to treatment with colloidal bismuth subcitrate (CBS) 240 mg twice daily or placebo, according to a double blind study design. After the blind treatment an 'open' treatment with CBS was started in both groups. Twenty six patients treated with CBS showed a significant reduction in colonisation with Campylobacter pyloni and a significant improvement in the Whitehead gastritis score. No significant changes were recorded in twenty four patients treated with placebo. After an additional course of CBS no further improvement in gastritis score was noted but there was a further reduction in Campylobacter colonisation. CBS did not greatly alter subjective complaints. Subjective complaints were improved in both treatment groups except for nausea and meteorism that improved more in the CBS treated patients. This finding again questions the clinical significance of gastritis and also casts doubt on the clinical relevance of therapeutical measures aimed at eradication of C pylon.Reports on the presence of spiral bacteria in the human stomach have appeared sporadically over the last century.' Since the work of Marshall and Warren, however, the possible pathogenetic significance of these organisms on type B (antral) gastritis was appreciated,4 and was confirmed by other investigators.5`Campylobacter pylori is found in 98% of patients with gastritis, in 80% of patients with gastric ulcer and in 90% of patients with duodenal ulcers. In patients with dyspeptic symptoms but normal gastric histology C pylori has also been seen overlying the mucosa but only in small numbers.' About one third of patients referred for upper gastrointestinal endoscopy because of upper abdominal complaints appear not to suffer from peptic ulcers, oesophagitis, active duodenitis, or gastric carcinoma and therefore by definition suffer from socalled non-ulcer dyspepsia. These patients constitute a heterogenous

SUMMARY Gastric biopsy specimens from 109 patients with non-ulcer dyspepsia were retrospectively examined. Sixty one patients had gastritis and there was a strong correlation with the presence of Campylobacter pyloridis. Ninety eight per cent were positive in large numbers for C pyloridis by histological examination or by culture, or both. Of 48 patients with normal histological results, 21 had evidence of C pyloridis by histological examination or culture, or both, but in small numbers. It is concluded that there is a quantitative rather than a qualitative association between C pyloridis and gastritis.Every year about 1% of the total population will seek medical advice about upper abdominal complaints.' In about two thirds of these patients peptic ulcer, oesophagitis, active duodenitis, or gastric and oesophageal cancer are diagnosed. In one third, however, upper gastrointestinal endoscopy or x-ray picture fail to show disease. These patients are therefore diagnosed as having so called non-ulcer dyspepsia. This group of patients is heterogenous, has disorders such as gallstones and motility disorders like the irritable bowel syndrome,2 and is notoriously difficult to manage. Histological examination will often show the presence of gastritis.5Marshall and Warren's report on Campylobacterlike organisms, subsequently designated C pyloridis and their association with gastritis,6 renewed interest in this condition.7 The nature of this association remains controversial,'" 12 but it has been shown that drugs active against C pyloridis can cure gastritis.'3 As yet no exact data are available on the prevalence of C pyloridis associated gastritis among patients with non-ulcer dyspepsia. We therefore studied prospectively the presence of C pyloridis in gastric mucosa of these patients by histological and microbiological examination, in the hope of identifying a subgroup of patients who would possibly benefit from antimicrobial treatment. Patients and methodsWe studied 109 consecutive patients referred to the Accepted for publication 14 July 1987 endoscopy department because of upper abdominal pain. Patients with gastric or duodenal ulcers, reflux oesophagitis, active duodenitis, gastrectomy and carcinoma were excluded. Also excluded were those who had taken corticosteroids, non-steroidal anti-inflammatory drugs, and antibiotics up to two weeks before endoscopy.A standard history was taken from all patients using a questionnaire, which included current complaints, smoking habits, alcohol consumption, medication, and family history of upper abdominal complaints and peptic ulcer disease (table 1).One hundred and nine patients were included, 50 men (mean age 43-3 years, range 18-75) and 59 women (mean age 56-5 years, range 16-82). All patients underwent upper gastrointestinal endoscopy with an Olympus GIF Q gastroscope. The macroscopic appearance of the upper gastrointestinal mucosa was recorded and biopsy specimens were taken from the gastric antrum for culture and histological examination.HISTOLOGY

Summary. An enzyme linked immunosorbent assay (ELISA) with a sonicated suspension of Helicobacter (Campylobacter) pylori as antigen was used to detect anti-H . pylori antibodies in 5 17 patients without dyspepsia or peptic ulcer symptoms and 401 healthy blood donors. The criterion of seropositivity was determined from a receiver operating curve computed with the values of optical densities of 48 sera from dyspeptic patients with proven helicobacter-associated gastritis and 16 sera from dyspeptic patients with proven helicobacter-associated gastritis and 16 sera from dyspeptic patients with normal antral mucosa and no microbiological or histological evidence of H . pylori infection. The 227 (44%) seropositive persons amongst the patient group appeared to be significantly higher than the 142 (35%) sera with antibodies in the blood donors tested (p < 0-03), even when adjustment was made for increasing age. We conclude that the prevalence of antibodies against H . pylori increases with age and that although antibodies are more prevalent in patients attending a hospital than in healthy blood donors, seropositivity suggestive of current or past infection can be found in one third of a randomly chosen population of blood donors.