In this study, researchers from Naples, Italy, evaluated the efficacy of a "Helicobacter pylori test and treat" strategy.
They compared this with an empirical trial of omeprazole, in the non-endoscopic management of young patients with dyspepsia.
|Endoscopy showed peptic ulcers only in group A.|
|British Medical Journal|
The research team performed a randomized controlled trial. They included 219 patients, less than 45 years old, who presented with dyspepsia without alarm symptoms.
Patients in group A received treatment with omeprazole 20 mg. Patients in group B received a urea breath test, followed by eradication treatment in case of H. pylori infection, or omeprazole alone in non-infected patients.
The team also performed endoscopy if there was a lack of improvement or recurrence of symptoms.
They measured patients' symptom improvement using a dyspepsia severity score every 2 months, use of medical resources, and clinical outcome.
The researchers found that 88% of patients in group A and 55% in group had endoscopy.
In 19 patients in group A and 32 in group B this was due to lack of improvement. In 77 further patients in group A and 29 in group B endoscopy was due to recurrence of symptoms during follow up.
Endoscopy showed peptic ulcers only in group A. However, esophagitis occurred significantly more often in group B than in group A.
The team found that about 80% of examinations were normal in both groups, but 9 duodenal scars occurred in group A.
Dr Gianpiero Manes's team concluded, "Eradication treatment allows resolution of symptoms in a large number of patients with dyspepsia and reduces the endoscopic workload".
"After a trial of omeprazole, symptoms recur in nearly every patient".
"Such treatment is also likely to mask an appreciable number of peptic ulcers and cases of esophagitis".