Randomised trial of endoscopy with testing for Helicobacter pylori compared with non-invasive H pylori testing alone in the management of dyspepsia

Abstract

Objective To compare the efficacy of non-invasive testing for Helicobacter pylori with that of endoscopy (plus H pylori testing) in the management of patients referred for endoscopic investigation of upper gastrointestinal symptoms. Design Randomised controlled trial with follow up at 12 months. Setting Hospital gastroenterology unit. Participants 708 patients aged under 55 referred for endoscopic investigation of dyspepsia, randomised to non-invasive breath test for H pylori or endoscopy plus H pylori testing. Main outcome measure Glasgow dyspepsia severity score at one year. Use of medical resources, patient oriented outcomes, and safety were also assessed. Results In 586 patients followed up at 12 months the mean change in dyspepsia score was 4.8 in the non-invasive H pylori test group and 4.6 in the endoscopy group (95% confidence interval for difference -0.7 to 0.5, P=0.69). Only 8.2% of patients followed up who were randomised to breath test alone were referred for subsequent endoscopy. The use of non-endoscopic resources was similar in the two groups. Reassurance value, concern about missed pathology, overall patient satisfaction, and quality of life were similar in the two groups. The patients found the non-invasive breath test procedure less uncomfortable and distressing than endoscopy with or without sedation. No potentially serious pathology requiring treatment other than eradication of H pylori was missed.

Prevalence of Esophageal Cancer in the Northern Part of Afghanistan

“…EGD has become more and more popular in the past 40 years with increasing frequency for examination of the upper gastrointestinal symptoms (McColl et al, 2002;Chan et al, 2004). The aim of EGD is to help both physician and patient to evaluate and to understand clinical symptoms besides acting as a tool to prove the presence of peptic ulcer or tumors (Maaroos et al, 2004).…”

Sensibilidad de la biopsia gástrica en la detección de Helicobacter pylori en pacientes en tratamiento con inhibidores de la bomba de protones

“…Los métodos no invasivos incluyen la detección del anticuerpo, prueba de antígeno en heces y la prueba de la urea espirada o test de aliento (9)(10)(11)16). …”

Test and treat or test and scope for Helicobacter pylori infection. Any change in gastric cancer prevention?

“…A recent large study demonstrated that this approach led to a dramatic reduction in the use of endoscopy in 'test and treat' patients over a 1-year period. 2 Gastric cancer remains a major public health issue. It is the second leading cause of cancer death world-wide 3 with approximately 1000 000 deaths per year.…”