At. Lassen et al., Helicobacter pylori test-and-eradicate versus prompt endoscopy for management of dyspeptic patients: a randomised trial, LANCET, 356(9228), 2000, pp. 455-460
Citations number
30
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Background Strategies based on screening for Helicobacter pylori to manage
dyspeptic patients in primary care have been proposed, but the clinical con
sequences are unclear. We did a randomised trial to assess the efficacy and
safety of a test-and-eradicate strategy compared with prompt endoscopy in
the management of patients with dyspepsia.
Methods 500 patients presenting in primary care with dyspepsia (greater tha
n or equal to 2 weeks of epigastric pain, no alarm symptoms) were assigned
H pylori testing plus eradication therapy or endoscopy. Symptoms, quality o
f life, patients' satisfaction, and use of resources were recorded during 1
year of follow-up.
Findings 250 patients were assigned lest-and-eradicate, and 250 prompt endo
scopy. The median age was 45 years and 28% were H pylori infected. 1 year f
ollow-up was completed by 447 patients. We found no differences in symptoms
between the two groups (median registered days without dyspeptic symptoms=
0.63 [IQR 0.27-0.81] in the test-and-eradicate group vs 0.67 [0.36-0.86] in
the prompt endoscopy group; mean difference 0.04 [95% CI -0.01-0.10], p=0.
12). Nor did we find any difference in quality of life or numbers of sick-l
eave days, Visits to general practitioners, or hospital admissions. In the
test-and-eradicate group, 27 (12%) of the patients were dissatisfied with m
anagement, compared with eight (4%) in the endoscopy group (p=0.013). After
1 year, the use of endoscopies in the test-and-eradicate group was 0.40 ti
mes (95% CI 0.31-0.51) the use in the endoscopy group, the use of H pylori
tests increased by a factor of 8.1 (5.7-13.1), the use of eradication treat
ments increased by a factor of 1.5 (0.9-2.7), and the use of proton-pump in
hibitors was 0.89 (0.59-1.33) times the use in the endoscopy group. 43 (91%
[80-98%]) of 47 peptic-ulcer patients would have been identified by endosc
opy or treated by eradication therapy.
Interpretation A H pylori test-and-eradicate strategy is as efficient and s
afe as prompt endoscopy for management of dyspeptic patients in primary car
e, although fewer patients are satisfied with their treatment.