Nonulcer dyspepsia (NUD) is a highly prevalent yet poorly understood condition. Although Helicobacter pylori infection and its associated chronic gastritis are very common in patients with NUD, there is no convincing evidence to support their etiologic role in this condition on the basis of current literature review, nor is there any evidence that H. pylori-induced chronic atrophic (type B) gastritis causes the symptoms observed in NUD. Most studies that attempted to correlate H. pylori and NUD, by epidemiologic or therapeutic intervention studies, were flawed by the lack of appropriately matched controls. Despite significant improvement observed in most therapeutic studies in histologic gastritis after treatment with bismuth-containing compounds, with or without antibiotic(s), there is conflicting evidence about whether treatment confers any clinical benefits on NUD symptomatology. A validated, universally accepted objective scoring system is desperately needed so that future controlled studies can adopt the same or a similar system to evaluate the results observed in different centers and populations. Until a definitive, positive association between H. pylori infection and NUD, such as H. pylori infection and peptic ulcer disease, has been established, it would be futile to routinely look for evidence of H. pylori infection and/or to treat the infection with eradication therapy.