EMPIRICAL H-2-BLOCKER THERAPY OR PROMPT ENDOSCOPY IN MANAGEMENT OF DYSPEPSIA

The recommended strategy for management of dyspepsia is empirical trea tment with an H-2-blocking drug, followed by endoscopy if the symptoms do not respond or recur. We compared two strategies for the managemen t of dyspepsia-treatment based on the results of prompt endoscopy (gro up 1) and empirical H-2-blocker treatment with diagnostic endoscopy on ly in cases of therapeutic failure or symptomatic relapse within 1 yea r (group 2). Eligible patients had symptoms severe enough to justify e mpirical H-2-blocker therapy. Symptoms, drug consumption, and sick-lea ve days were assessed through monthly diaries. Patients with non-organ ic dyspepsia diagnosed by endoscopy did not receive ulcer drugs. Of 41 4 patients randomised, 373 completed 1-year follow-up. Organic disease was found at endoscopy in 68 (33%) of 208 group-1 patients (ulcer in 45). Endoscopy was done in 136 (66%) of 206 group-2 patients. Case sel ection for endoscopy was not improved by the empirical treatment strat egy, since the diagnostic profile was the same as in group 1 and 40% o f the expected ulcer cases remained undiagnosed. After 1 year there we re no differences in symptoms or quality of life measures. The empiric al treatment strategy in dyspepsia was associated with higher costs, d ue mainly to a higher number of sick-leave days and cost of ulcer drug use. Prompt endoscopy is a cost-effective strategy in dyspeptic patie nts with symptoms severe enough to justify the current practice of emp irical H-2-blocker treatment.