Investigators from Canada determined whether a "test for Helicobacter pylori and treat" strategy improves symptoms in patients with uninvestigated dyspepsia in primary care.
Included in the randomized placebo controlled trial were 294 patients positive for H. pylori (13C- urea breath test). All had symptoms of dyspepsia of at least moderate severity in the preceding month.
Participants were randomized to twice daily treatment for 7 days with omeprazole 20 mg, metronidazole 500 mg, and clarithromycin 250 mg, or omeprazole 20 mg, placebo metronidazole, and placebo clarithromycin.
Patients were then managed by their family physicians according to their usual care.
| Eradication treatment reduced mean annual cost by $83 per patient.
| British Medical Journal |
The researchers looked at treatment success, defined as no symptoms or minimal symptoms of dyspepsia at the end of 1 year.
Societal healthcare costs, collected prospectively, were used for a secondary evaluation of actual mean costs.
Eradication treatment was significantly more effective than placebo in achieving treatment success (50% vs 36%; absolute risk reduction = 14%).
The authors found that eradication treatment cured H. pylori infection in 80% of evaluable patients.
Furthermore, treatment success at 1 year was greater in patients negative for H. pylori than in those positive for H. pylori (54% vs 39%).
Eradication treatment reduced mean annual cost by $83 per patient.
Naoki Chiba, of McMaster University, Hamilton, Canada, concluded on behalf of the group, "A ‘test for H. pylori with 13C-urea breath test and eradicate' strategy shows significant symptomatic benefit at 12 months in the management of primary care patients with uninvestigated dyspepsia."