Help
Subscribe


GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy

 18 January 2018

Advanced search
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

Step-up vs step-down therapy with H2-receptor antagonists and PPIs in dyspepsia

This week’s The Lancet examines the effect and cost-effectiveness of step-up vs step-down treatment with antacids, H2-receptor antagonists, and PPIs with new onset dyspepsia.

News image

fiogf49gjkf04

Substantial physician workload and high costs are associated with the treatment of dyspepsia in primary health care.

Despite the availability of consensus statements and guidelines, the most cost-effective empirical strategy for initial management of the condition remains to be determined.

Dr Corine van Marrewijk and colleagues from the Netherlands compared step-up and step-down treatment strategies for initial management of patients with new onset dyspepsia in primary care.

Patients aged 18 years and older who consulted with their family doctor for new onset dyspepsia in the Netherlands were eligible for enrolment in this double-blind, randomized controlled trial.

1 or more adverse drug events were reported by 28% in the step-up group
The Lancet

Between 2003 and 2006, 664 patients were randomly assigned to receive stepwise treatment with antacid, H2-receptor antagonist, and proton pump inhibitors, or these drugs in the reverse order.

The patients were randomized by use of a computer-generated sequence with blocks of 6.

The team found each step lasted 4 weeks, and treatment only continued with the next step if symptoms persisted or relapsed within 4 weeks.

Primary outcomes were symptom relief and cost-effectiveness of initial management at 6 months.

Analysis was by intention to treat; the intention to treat population consisted of all patients with data for the primary outcome at 6 months.

The researchers found that 332 patients in the step-up, and 313 in the step-down group reached an endpoint with sufficient data for evaluation.

The main reason for dropout was loss to follow-up.

Treatment success after 6 months was achieved in 72% of patients in the step-up group and 70% of patients in the step-down group.

The team found that the average medical costs were lower for patients in the step-up group than for those in the step-down group, which was mainly because of costs of medication.

The research team noted that 1 or more adverse drug events were reported by 28% of patients in the step-up, and 29% of patients in the step-down group.

All were minor events, including dyspeptic symptoms, diarrhea, constipation, and bad/dry taste.

Dr van Marrewijk and colleagues concluded, “Although treatment success with either step-up or step-down treatment is similar.”

“The step-up strategy is more cost effective at 6 months for initial treatment of patients with new onset dyspeptic symptoms in primary care.”

Lancet 2009: 373(9659): 215-25


21 January 2009

Go to top of page Email this page Email this page to a colleague

 18 January 2018 
Sleeve gastrectomy vs Roux-en-Y gastric bypass
 18 January 2018 
Healthcare costs of liver cancer in the USA
 18 January 2018 
High-risk adenomas at colonoscopy
 17 January 2018 
“Weekend effect” in upper GI hemorrhage
 17 January 2018 
Gut dysbiosis and non-antibiotic prescription medications
 17 January 2018 
Reducing surgical infections in high-outlier colorectal unit
 16 January 2018 
Bundle of care in GI cancer surgery
 16 January 2018 
Anxiety about colonoscopy
 16 January 2018 
Thiopurines and colorectal neoplasia in IBD
 15 January 2018 
Risks of death after liver transplants for liver cancer
 15 January 2018 
Recent advances in hepatocellular carcinoma
 15 January 2018 
Ileostomy output using telemedicine
 12 January 2018 
Surveillance protocols after colorectal cancer resection
 12 January 2018 
Biologic therapy by pregnant women with IBD and infant vaccines
 12 January 2018 
Biologic therapies for IBD in the USA
 11 January 2018 
Genetic risk factors in GERD
 11 January 2018 
Predictor of colorectal adenoma
 11 January 2018 
Ectopic pregnancy in IBD 
 10 January 2018 
Fecal immunochemical tests for colorectal cancer screening
 10 January 2018 
Risk factors for advanced NAFLD
 10 January 2018 
Dyspepsia prevalence with gastroesophageal reflux–type symptoms
 09 January 2018 
Screening intervals for people with family histories of colorectal cancer
 09 January 2018 
Financial impact of colorectal cancer
 09 January 2018 
Current practice and future research in autoimmune hepatitis
 08 January 2018 
Improving prognosis in patients with primary sclerosing cholangitis
 08 January 2018 
Reliability of the IBD index
 08 January 2018 
Aprepitant and nausea with gastroparesis
 05 January 2018 
Autoimmune pancreatitis and IBD
 05 January 2018 
Primary nonresponse to infliximab therapy
 05 January 2018 
Anesthesia assistance in outpatient colonoscopy
 04 January 2018 
Dietary polyphenols in the etiology of IBD
 04 January 2018 
Yoga vs low-FODMAP in IBS
 04 January 2018 
Local esophageal food allergen injections in eosinophilic esophagitis
 03 January 2018 
Population health management for IBD
 03 January 2018 
GERD in asthma and COPD
 03 January 2018 
Critical research gaps in colorectal cancer
 22 December 2017 
Costs of extrahepatic manifestations of Hep C
 22 December 2017 
Cholera vaccine and risk of death in colorectal cancer
 22 December 2017 
Colonoscopy after colorectal cancer resection
 21 December 2017 
Human oral microbiome and pancreatic cancer risk
 21 December 2017 
Health management for IBD
 21 December 2017 
PPI and Alzheimer's disease
 20 December 2017 
Management of abnormal liver blood tests
 20 December 2017 
Incidence of biopsy-verified celiac disease
 20 December 2017 
Osteoporotic fractures in Barrett's esophagus
 19 December 2017 
Alcohol abstinence and alcoholic hepatitis
 19 December 2017 
Family burden of pediatric Crohn's in the USA
 19 December 2017 
Early readmission in IBD patients
 18 December 2017 
Colorectal cancer mortality with low-risk adenomas at colonoscopy
 18 December 2017 
Disease activity indices in celiac disease
 18 December 2017 
Smoking behaviour predicted the risk of surgery in Crohn's
 15 December 2017 
Molecular classification of Crohn's disease
 15 December 2017 
Medical cannabinoid legalization policy and vomiting
 15 December 2017 
Inflammatory diet pattern and colorectal cancer risk
 14 December 2017 
PPIs and gastric cancer after H.pylori eradication
 14 December 2017 
H. pylori eradication therapies in countries with clarithromycin resistance
 13 December 2017 
Disease severity in NAFLD
 13 December 2017 
Tryptophan metabolism and IBD activity
 12 December 2017 
Risk factors in undiagnosed cirrhosis
 12 December 2017 
Monitored anesthesia care for outpatient GI endoscopy

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2018 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us