A prospective study of the management of the young Helicobacter pylori negative dyspeptic patient - can gastroscopies be saved in clinical practice?

Background Helicobacter pylori status has been suggested as a means of sele cting young dyspeptic patients for gastroscopy as patients who are H. pylor i negative and do not exhibit alarm symptoms or ingest non-steroidal anti-i nflammatory medication have a low risk of serious organic disease, Aim To determine if young patients with ulcer-like dyspepsia and found to b e H. pylori negative on noninvasive testing could be reassured by this know ledge and not proceed to gastroscopy Patients One hundred and sixty-one consecutive attendees aged 45 years or l ess with a presenting complaint of epigastric pain or discomfort were prosp ectively recruited from open access gastroscopy referrals and gastroenterol ogy clinics. Methods Patients who were H. pylori negative on 13-carbon urea breath test were reassured of the likelihood of a normal gastroscopy, given lifestyle a dvice and also advised to take symptomatic therapy as required, Patients we re reviewed at 6 weeks, 3 months and 6 months when symptoms and quality of life were reassessed. Patients proceeded to gastroscopy if at any review th eir dyspepsia score stayed the same or worsened. Results Fifty-five H. pylori negative patients were recruited (30 male, mea n age 31 years), two patients did not attend subsequent review. Thirty-two (58%) came to gastroscopy. Endoscopic diagnoses included 25 which were norm al, three with gastro-oesophageal reflux disease, three with peptic ulcer d isease and one with gastric erosions. Dyspepsia and quality of life scores showed significant improvement over 6 months. Conclusions This management strategy resulted in a 42% reduction in gastros copies in H. pylori negative patients. Whilst the majority of patients endo scoped had normal findings, seven patients (22%) had pathology. Overall the re were significant improvements in dyspepsia and quality of life at 6 mont h follow-up, Eur J Gastroenterol Hepatol 10:953-956 (C) 1998 Lippincott Wil liams & Wilkins.