NEW YORK, August 7 (Praxis Press) Dyspepsia encompasses a range of pathologies, and the most cost-effective approach for assessing and managing this symptom is debated. Lassen and colleagues compared the safety and efficacy of a Helicobacter pylori test-and-eradicate strategy with a prompt endoscopy strategy in 500 patients presenting with dyspepsia. One year after treatment, there were no differences between the two groups in the frequency of gastrointestinal symptoms, quality of life, number of sick-leave days, visits to general practitioners, or hospital admissions. Nonetheless, dissatisfaction with treatment was more common in the test-and-eradicate group (12%) than in the endoscopy group (4%). Ninety-one percent of patients with peptic ulcers in the prompt endoscopy group would have been either treated with eradication therapy or subsequently identified by endoscopy had they been assigned to the test-and-eradicate group. An H. pylori test-and-eradicate strategy is a safe and effective alternative to prompt endoscopy for patients with dyspepsia, although some patients may be unhappy with this approach.