Meta‐analysis: Helicobacter pylori‘test and treat’ compared with empirical acid suppression for managing dyspepsia

Abstract

SUMMARY BackgroundWhich of Helicobacter pylori 'test and treat' or empirical acid suppression should be preferred for the initial management of uncomplicated dyspepsia is controversial.

ACG and CAG Clinical Guideline: Management of Dyspepsia

“…Th ere was no statistically signifi cant diff erence between the two strategies (RR=0.89; 95% CI=0.77-1.04) ( Appendix 2 ; Appendix Figure 5 ). A systematic review ( 50 ) found there was a trend towards a reduction in cost for H. pylori test and treat compared to empirical PPI therapy, but this was not statistically signifi cant. Th e trend for both benefi t and costs favored H. pylori test and treat compared to empirical PPI and, therefore, the group felt this was the preferred initial strategy with acid suppression reserved for those who were H. pylori negative or who continued to have symptoms despite eradication therapy.…”

Symptoms in patients on long‐term proton pump inhibitors: prevalence and predictors

“…13,20 Studies have shown that testing and treating for H. pylori in uninvestigated dyspepsia (UID) and non-ulcer dyspepsia (NUD) are likely to be beneficial in a significant number of patients. [21][22][23][24] However, these studies have included patients with de novo dyspepsia symptoms without previous use of acid suppression drugs or patients with peptic ulcer disease 25 and the findings may not apply to patients on longterm PPIs without ulcer disease. This study examines the prevalence of dyspepsia symptoms and quality-of-life in patients with longterm use of PPI treatment.…”

Helicobacter pylori eradication in long‐term proton pump inhibitor users is highly cost‐effective: economic analysis of the HELPUP trial

“…Patients enrolled in this study are likely to have had heterogeneous causes for their dyspepsia, but the intervention reflects recent NICE and SIGN guidelines, 17,18 which recommend empirical use of PPI therapy for dyspepsia without alarm symptoms in primary care. Previous trials comparing test-and-treat with empirical acid suppression 8,23 found an overall nonsignificant trend towards cost savings (three trials with 12-month follow-up). These previous trials differ in three respects.…”