The evaluation of dyspepsia may include a Helicobacter pylori test-and-treat strategy, empiric acid suppression, and initial endoscopy.
In this study, researchers from Nashville, Tennessee, evaluated endoscopy yield in patients where empiric therapy was unsuccessful, versus patients who have not received empiric therapy. They also identified the factors associated with endoscopic findings.
The team evaluated 100 patients with dyspepsia who were referred for endoscopy using a questionnaire.
|Fewer patients taking PPIs had esophagitis or ulcers.|
They then compared EGD findings in patients taking an H2-receptor antagonist, patients taking a proton pump inhibitor (PPI), and those not receiving empiric therapy.
The researchers found that there were fewer endoscopic findings in patients taking a PPI, compared with those taking an H2-receptor antagonist, or those not receiving therapy.
Furthermore, fewer patients taking PPIs had esophagitis or ulcers, compared with patients not receiving any therapy.
The team also determined that lack of symptom relief by acid suppression was highly associated with a normal endoscopy.
Dr Terrence Smith's team concluded, "Patients with persistent dyspepsia being treated with a PPI have fewer endoscopic abnormalities compared with patients with dyspepsia taking an H2-receptor antagonist and those receiving no therapy.
"For patients with partial symptom relief, PPI therapy may mask endoscopic findings, particularly esophagitis".
"Interruption of PPIs before endoscopy may increase diagnostic yield".
"Endoscopy is unlikely to yield a positive finding in patients who experience no symptom relief while taking a PPI or H2-receptor antagonist".