Zheleznov S, et al. - This inquiry was set up to investigate Helicobacter pylori (HP) and upper gastrointestinal lesions as signs of inflammation independently of each other in the pathogenesis of chronic spontaneous urticaria (CSU). It was shown that independently of HP, upper gastrointestinal inflammatory disorders could cause CSU and trigger exacerbations. This might imply that also in HP-positive patients, urticaria is not based on an immunological reaction against the germ but rather on the underlying inflammation. The significance of a gastroenterological workup of patients with CSU was also strengthened.