Objective: To determine the impact of a community based Helicobacter pylori screening and eradication programme on the incidence of dyspepsia, resource use, and quality of life, including a cost consequences analysis. Design: H pylori screening programme followed by randomised placebo controlled trial of eradication. Setting: Seven general practices in southwest England. Participants: 10 537 un-selected people aged 20 - 59 years were screened for H pylori infection (13C urea breath test); 1558 of the 1636 participants who tested positive were randomised to H pylori eradication treatment or placebo, and 1539 (99%) were followed up for two years. Intervention: Ranitidine bismuth citrate 400 mg and clarithromycin 500 mg twice daily for two weeks or placebo. Main outcome measures: Primary care consultation rates for dyspepsia (defined as epigastric pain) two years after randomisation, with secondary outcomes of dyspepsia symptoms, resource use, NHS costs, and quality of life. Results: In the eradication group, 35% fewer participants consulted for dyspepsia over two years compared with the placebo group (55/787 v 78/ 771; odds ratio 0.65, 95% confidence interval 0.46 to 0. 94; P = 0. 021; number needed to treat 30) and 29% fewer participants had regular symptoms (odds ratio 0. 71, 0.56 to 0.90; P = 0.05). NHS costs were ￡84.70 ( ￡74.90 to ￡93.91) greater per participant in the eradication group over two years, of which ￡83. 40 ($146; (?) 121) was the cost of eradication treatment. No difference in quality of life existed between the two groups. Conclusions: Community screening and eradication of H pylori is feasible in the general population and led to significant reductions in the number of people who consulted for dyspepsia and had symptoms two years after treatment These benefits have to be balanced against the costs of eradication treatment, so a targeted eradication strategy in dyspeptic patients may be preferable. Objective: To determine the impact of a community based on Helicobacter pylori screening and eradication program on the incidence of dyspepsia, resource use, and quality of life, including a cost consequences analysis. Design: H pylori screening program followed by randomized placebo controlled trial of eradication Participants: 10 537 un-selected people aged 20 - 59 years were screened for H pylori infection (13C urea breath test); 1558 of the 1636 participants who tested positive were randomized to H pylori eradication Treatment or placebo, and 1539 (99%) were followed up for two years. Intervention: Ranitidine bismuth citrate 400 mg and clarithromycin 500 mg twice daily for two weeks or placebo. Main outcome measures: Primary care consultation rates for dyspepsia (defined as epigastric pain) two years after randomisation, with secondary outcomes of dyspepsia symptoms, resource use, NHS costs, and quality of life. Results: In t 35% fewer participants consulted for dyspepsia over two years than with the placebo group (55/787 v 78/771; odds ratio 0.65, 95% confidence interval 0.46 to 0.94; P = 0. 021; number needed to treat 30) and 29% fewer participants had regular symptoms (odds ratio 0.71, 0.56 to 0.90; P = 0.05). NHS costs were £ 84.70 (£ 74.90 to £ 93.91) greater per participant in the eradication group over two years , of which £ 83. 40 ($ 146; (?) 121) was the cost of eradication treatment. No difference in quality of life existed between the two groups. Conclusions: Community screening and eradication of H pylori is feasible in the general population and led to significant reductions in the number of people who consulted for dyspepsia and had symptoms two years after treatment These benefits have to be balanced against the costs of eradication treatment, so a targeted eradication strategy in dyspeptic patients may be preferable.