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News

H pylori test and eradicate vs prompt endoscopy for dyspepsia

On a long term basis, a H pylori test and eradicate strategy is as efficient as prompt endoscopy for management of dyspeptic patients in primary care and reduces the use of endoscopy and antisecretory medication, reports the most recent issue of Gut.

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Dyspepsia is a chronic disease with significant impact on the use of health care resources.

A management strategy based on Helicobacter pylori (H pylori) testing has been recommended but the long term effect is unknown.

Dr Lassen and colleagues from Denmark undertook a study to investigate the long term effect of a test and treat strategy compared with prompt endoscopy for management of dyspeptic patients in primary care.

The researchers included a total of 500 patients presenting in primary care with dyspepsia.

The research team randomized the participants to either management by H pylori testing plus eradication therapy or by endoscopy.

The researchers recorded symptoms, quality of life, and patient satisfaction during a 3 month period, a median 6.7 years after randomization.

Median proportion of days without symptoms was 0.52 in the test and eradicate group vs 0.64 in the prompt endoscopy group
Gut

The research group also recorded the number of endoscopies, antisecretory medication, H pylori treatments, and hospital visits using from health care databases for the entire follow up period.

Median age was 45 years; 28% were H pylori infected.

Use of resources was registered in all 500 patients (3084 person years) of whom 312 completed diaries.

The researchers found no difference in symptoms between the two groups.

The research team also found that the median proportion of days without symptoms was 0.52 in the test and eradicate group versus 0.64 in the prompt endoscopy group.

Compared with the prompt endoscopy group, the test and eradicate group underwent fewer endoscopies and used less antisecretory medication.

Dr Lassen concluded, "On a long term basis, a H pylori test and eradicate strategy is as efficient as prompt endoscopy for management of dyspeptic patients in primary care and reduces the use of endoscopy and antisecretory medication."

Gut; 2004: 53:1758-1763
15 November 2004

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