A rational approach to uninvestigated dyspepsia in primary care: review of the literature

Abstract

In this paper the rationale and limitations of the four most important approach strategies to dyspepsia in primary care (empiric treatment, prompt endoscopy, “test-and-scope”, and “test-and-treat”) are analysed. It is concluded that in the absence of alarm symptoms, a “test-and-treat” approach is currently the most rational approach provided that three conditions are met: (1) a highly accurate test should be used, (2) the prevalence of Helicobacter pylori in the population should not be too low, and (3) an effective anti-H pylori regimen should be prescribed taking sufficient time to instruct and motivate the patient.

Observational comparative trial of the efficacy of proton pump inhibitors versus histamine‐2 receptor antagonists for uninvestigated dyspepsia

“…Arents et al. summarized the prevalence of endoscopically diagnosed disease in dyspeptic patients: 2–31% reflux esophagitis, 13–28% peptic ulcer disease, 0.2–4.0% malignancy and 35–89% functional dyspepsia 10 . Among patients with uninvestigated dyspepsia, endoscopic esophagitis is very common regardless of their predominant symptom; 11 namely, 35% of dysmotility‐like patients are diagnosed as having reflux esophagitis or peptic ulcer.…”

A One-Year Economic Evaluation of Six Alternative Strategies for the Management of Uninvestigated Upper Gastrointestinal Symptoms in Canadian Primary Care

“…However, here too (even though accepting and quantifying uncertainty is an aim of cost-effectiveness analyses), many factors may limit analytical conclusions such as the following: disparate modelling methodologies, variations in study parameters such as study design, strategies (some now outdated), patient populations, base case assumptions, measurements of outcome and time horizons. This is especially true because decision models generally also incorporate data from disparate trials, and are highly influenced by parameters such as endoscopy costs, treatment and physician visits, the prevalence of H pylori, the specificity of diagnostic tests, as well as the short-and longterm benefits of H pylori eradication in patients with functional nonulcer dyspepsia (44).…”

The study of risk factors associated with dyspepsia

“…[1] Organism plays a major role in several upper gastrointestinal diseases which present as dyspepsia. [9,10] It is a major etiological factor in peptic ulcer disease, gastric carcinoma, and gastric mucosal associated lymphoid tissue (MALT) lymphoma. [11][12][13] The strong association of H. pylori with dyspepsia has caused a major paradigm shift in patients' management.…”