A prospective study of the management of the young Helicobacter pylori negative dyspeptic patient - can gastroscopies be saved in clinical practice?

Heaney, April; Collins, J. S. A.; Tham, T. C. K.; Watson, Peter; McFarland, James; Bamford, Kathleen B.

doi:10.1097/00042737-199811000-00009

Cited by 20 publications

(9 citation statements)

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“…In this group 25% were positive for H. pylori (Ng et al 1997). Heaney et al (1998) have suggested that H. pylori infection status can be used as a criterion to select patients for gastroscopy when determining management of young dyspeptic patients. In this study 160 "young" patients (<45 years of age) were prospectively recruited when presenting with the complaint of epigastric pain and/or discomfort.…”

Section: Helicobacter Pylori Infection In Childrenmentioning

confidence: 99%

Diagnostic Nuclear Medicine

2006

Medical Radiology

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Section: Helicobacter Pylori Infection In Childrenmentioning

confidence: 99%

Diagnostic Nuclear Medicine

2006

Medical Radiology

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“…Helicobacter pylori status has been suggested as a means of selecting young dyspeptic patients for gastroscopy, the rationale being that the endoscopic yield in the H pylori negative patients is small1 and that gastroscopies may be avoided if H pylori negative patients are not endoscoped but treated symptomatically 23 Management strategies for H pylori positive patients remain controversial.…”

mentioning

confidence: 99%

A prospective randomised trial of a “test and treat” policy versus endoscopy based management in youngHelicobacter pylori positive patients with ulcer-like dyspepsia, referred to a hospital clinic

Heaney

Collins

Watson

et al. 1999

Gut

131

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Background-Management of dyspepsia remains a controversial area. Although the European Helicobacter pylori study group has advised empirical eradication therapy without oesophagogastroduodenoscopy (OGD) in young H pylori positive dyspeptic patients who do not exhibit alarm symptoms, this strategy has not been subjected to clinical trial. Aims-To compare a "test and treat" eradication policy against management by OGD. Patients-Consecutive subjects were prospectively recruited from open access OGD and outpatient referrals. Methods-H pylori status was assessed using the carbon-13 urea breath test. H pylori positive patients were randomised to either empirical eradication or OGD. Symptoms and quality of life scores were assessed at baseline and subsequent reviews over a 12 month period. Results-A total of 104 H pylori positive patients aged under 45 years were recruited. Fifty two were randomised to receive empirical eradication therapy and 52 to OGD. Results were analysed using an intention to treat policy. Dyspepsia scores significantly improved in both groups over 12 months compared with baseline; however, dyspepsia scores were significantly better in the empirical eradication group. Quality of life showed significant improvements in both groups at 12 months; however, physical role functioning was significantly improved in the empirical eradication group. Fourteen (27%) in the empirical eradication group subsequently proceeded to OGD because of no improvement in dyspepsia. Conclusions-This randomised study strongly supports the use of empirical H pylori eradication in patients referred to secondary practice; it is estimated that 73% of OGDs in this group would have been avoided with no detriment to clinical outcome. (Gut 1999;45:186-190)

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“…In a prospective trial with a non-randomized control group, the H. pylori-negative patients who did not undergo endoscopy had similar outcomes to those who underwent the procedure with a resultant 37% reduction in endoscopies [36]. Moreover, a recent prospective study revealed that reassurance of a normal endoscopy may result in a 42% reduction in procedures in H. pylori-negative patients [40]. In a randomized clinical trial, H. pylori-seronegative dyspeptics were allocated to endoscopy or no endoscopy and followed for 6 months.…”

Section: Endoscopy Versus Radiographymentioning

confidence: 95%

What have we learned from recent dyspepsia trials?

Ofman

2000

Curr Gastroenterol Rep

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Dyspepsia is a common disorder and a frequent complaint of patients presenting for primary care. Understanding of the role of Helicobacter pylori has led to re-evaluation of management strategies for these patients. This article highlights results from clinical trials that have helped to clarify the role of empiric therapy, endoscopy, radiography, and H. pylori eradication in patients with nonulcer dyspepsia.

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A prospective study of the management of the young Helicobacter pylori negative dyspeptic patient - can gastroscopies be saved in clinical practice?

Cited by 20 publications

References 0 publications

Diagnostic Nuclear Medicine

Diagnostic Nuclear Medicine

A prospective randomised trial of a “test and treat” policy versus endoscopy based management in youngHelicobacter pylori positive patients with ulcer-like dyspepsia, referred to a hospital clinic

What have we learned from recent dyspepsia trials?

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