The effectiveness of screening and treating Helicobacter pylori in the management of dyspepsia

Aims (1) To investigate the effects of a Helicobacter pylori screening and treatment strategy on open access endoscopy referral rates in dyspeptic pat ients aged < 40 years. (2) To determine the effectiveness of an H. pylori s creening and treatment strategy, compared with endoscopy, in reducing dyspe ptic symptoms, and in the utilization of dyspepsia related health care in g eneral practice. Subjects Subjects were dyspeptic patients aged < 40 years, who were not tak ing NSAIDs and were without sinister symptoms. Patients were referred by th eir general practitioners. Methods The proportion of endoscopies carried out in patients aged < 40 yea rs during the 5 years before the introduction of a screening and treatment strategy was compared with the proportion 2 years afterwards, as determined in a retrospective audit Dyspepsia scores were obtained from unselected en doscopy patients and those who received a C-13-urea breath test (C-13-UBT) at their initial visit and 6 months later. The number of visits made by pat ients with dyspepsia to their GPs, as well as the number of prescriptions g iven for antisecretory drugs, during the 6 months before attending for inve stigation were compared, in the same patient groups, with the same variable s during the 6 months after the investigation. Results There was a 37% reduction in open access endoscopies performed in p atients aged < 40 years (95% CI, 34-40%) following the introduction of the 13C-UBT service. Six months after attending the C-13-UBT service there was a significant fall in dyspepsia score (15.5 +/- 7.4 to 7.2 +/- 7.0, P < 0.0 001), general practice dyspepsia consultations (2.0 +/- 1.3 to 1.0 +/- 1.7, P < 0.0001), H-2 receptor antagonist prescription (14.2 +/- 32.6 tablets t o 6.7 +/- 25.6 tablets, P = 0.006) but not proton pump inhibitor prescripti on (6.9 +/- 21.9 tablets to 7.2 +/- 27.6 tablets, P = 0.90). These changes were not significantly different from those found in the open access endosc opy control patients. Conclusions An H. pylori screening and treatment strategy reduces the endos copy workload in young dyspeptic patients. This strategy appears to be as e ffective as endoscopy in reducing dyspepsia symptoms, dyspepsia consultatio n rates and the prescribing of anti-secretory drugs. Eur J Gastroenterol He patol 11:1245-1250 (C) 1999 Lippincott Williams & Wilkins.