If you have chronic stomach discomfort, your first line of attack should be the ulcer bacterium Helicobacter pylori, according to a recent study.

Chronic dyspepsia -- discomfort in the upper abdomen that is sometimes accompanied by nausea and vomiting -- requires treatment. A study reported in the American Journal of Gastroenterology (Volume 101, page 1200) finds that testing for -- and eradicating -- the ulcer bacterium Helicobacter pylori may be helpful.

Typically, acid reflux or an H. pylori infection is to blame for dyspepsia. Thus, the usual treatment is a proton pump inhibitor (to reduce acid) or antibiotic therapy (to eradicate H. pylori).

In the study, researchers used three treatment strategies: 222 people were treated with the proton pump inhibitor esomeprazole (Nexium), 250 were tested for H. pylori and given antibiotics if the results were positive, and 250 were given Nexium and then tested for H. pylori if their symptoms improved. One year later, those given Nexium only were 36% more likely to eventually need upper endoscopy, compared with 22–28% of those in the two test-and-eradicate groups. Also, H. pylori–positive participants in the test-and-eradicate groups had more symptom-free days, used less medication, and were more satisfied with their treatment than H. pylori–negative participants.

Bottom-line advice: If you have dyspepsia, it might be worthwhile to get tested for H. pylori infection. If the test comes back positive, you should consider undergoing antibiotic therapy to eradicate the infection.