We thank Bornschein et al for their interest in the British Society of Gastroenterology guidelines on the management of functional dyspepsia (FD).1 2 They raise issues regarding the role of repeated Helicobacter pylori testing and eradication in patients with uninvestigated dyspepsia, as part of a ‘test and treat’ approach, which is the most effective strategy for managing the condition.3 However, they extrapolate this to cover FD, although most patients with uninvestigated dyspepsia will have FD as the cause of symptoms.4

We agree that H. pylori leads to severe complications including peptic ulcer or gastric cancer. There is unequivocal evidence that eradicating the bacterium in patients with peptic ulcer leads to a …