Approach to Treatment of Dyspepsia in Primary Care

Abstract

The test-and-treat strategy proved to be as effective and safe as prompt endoscopy. Only a minority of patients were referred for endoscopy after the test-and-treat approach.

Helicobacter Pylori “Test-and-Treat” Strategy for Management of Dyspepsia: A Comprehensive Review

“…The test-and-treat strategy has been compared with prompt endoscopy in eight RCTs (Table 1), 17, 18, 19, 20, 21, 22, 23, 24 which differ in important ways: in three trials 17, 19, 20 patients were recruited and randomized at the endoscopy unit after their general practitioner had referred them for investigation; in five trials 18, 21, 22, 23, 24 patients were randomized in primary care. It is noteworthy that the studies by Jones et al 18 and Duggan et al 24 used near-patient serology, which has very poor accuracy for the diagnosis of H. pylori infection; this important drawback markedly reduces the reliability of results.…”

“…It is noteworthy that the studies by Jones et al 18 and Duggan et al 24 used near-patient serology, which has very poor accuracy for the diagnosis of H. pylori infection; this important drawback markedly reduces the reliability of results. 25 Furthermore, Arents et al 21 used the serology result from a venous blood sample to diagnose H. pylori infection; although more reliable than office serology, this test is far less accurate than the 13 C-urea breath test, which was the diagnostic test in the remaining studies. Three studies recruited only individuals <45 years of age, 17, 18, 23 two studies set the age cutoff at 55 years, 20, 21 and no age limit was applied in the remaining three studies.…”

“…25 Furthermore, Arents et al 21 used the serology result from a venous blood sample to diagnose H. pylori infection; although more reliable than office serology, this test is far less accurate than the 13 C-urea breath test, which was the diagnostic test in the remaining studies. Three studies recruited only individuals <45 years of age, 17, 18, 23 two studies set the age cutoff at 55 years, 20, 21 and no age limit was applied in the remaining three studies. 19, 22, 24 Most studies randomized participants to H. pylori testing or endoscopy, but Heaney et al 17 randomized only H. pylori -positive patients to either treatment or prompt endoscopy.…”

“…One small study reported significantly lower symptom scores in subjects randomized to test-and-treat at 12 months. 17 Seven of the above-mentioned trials reported cost data and all demonstrated a significant reduction in the total number of endoscopies with a test-and-treat strategy, 18, 19, 20, 21, 22, 23, 24 with two studies reporting that test-and-treat was the most cost-effective management strategy. 22, 24 Follow-up in all these studies was limited to 12 months, so it is uncertain whether the observed cost reductions generated using the test-and-treat strategy instead of prompt endoscopy is sustained in the long term.…”

Helicobacter pylori eradication therapy in nonulcer dyspepsia is beneficial

“…Because this was a retrospective, unmatched nonconsecutive controlled study, the results are difficult to interpret. Additional randomized trial data[54] and a Cochrane metaanalysis[55] suggest overall that prompt EGD and test-and-treat have similar efficacy.…”