 |  Proton Pump Inhibitor or Testing for Helicobacter pylori as the First Step for Patients Presenting with Dyspepsia? A Cluster-Randomized Trial
Dorte Ejg Jarbol, M.D., Ph.D. 1,2 , Jakob Kragstrup, M.D., D.Med.Sci., Ph.D. 2 , Henrik Stovring, M.Sc., Ph.D. 2 , Troels Havelund, M.D. 1 , and Ove B. Schaffalitzky de Muckadell, M.D., D.Med.Sci. 1
Affiliations
1Department of Medical Gastroenterology, Odense University Hospital, Odense Denmark
2Research Unit of General Practice, University of Southern Denmark, Denmark
OBJECTIVES: The optimal approach for management of patients with dyspepsia has not been determined. The aim of this study was to compare the efficacy of three strategies for management of dyspepsia: empirical antisecretory therapy, testing for Helicobacter pylori (H. pylori), or a combination of the two.
METHODS: Cluster-randomized trial in general practices. Initial treatment with proton pump inhibitor (PPI) was performed in 222 patients, H. pylori test-and-eradicate in 250 patients, and PPI followed by H. pylori-testing if symptoms improved in 250 patients. Symptoms, quality of life, patient satisfaction, and use of resources were recorded during a 1-yr follow-up.
RESULTS: The prevalence of H. pylori infection was 24%. We found no difference among the three strategies (p = 0.16) in terms of the proportion of days without dyspeptic symptoms. After 1 yr gastrointestinal symptom scores and quality-of-life scores had improved significantly and equally in the three groups (p < 0.001), but no statistically significant differences were found among the groups. The mean use of endoscopies per patient after 1 yr was higher in the PPI group (0.36 [95% CI 0.30–0.43]) than in the test-and-eradicate group (0.28 [95% CI 0.23–0.34]) and the combination group (0.22 [95% CI 0.17–0.27]), p = 0.02. H. pylori-positive patients given eradication therapy had more days without dyspeptic symptoms (p < 0.001), used less antisecretory therapy (p < 0.01), and were more satisfied (p < 0.001) than H. pylori-negative patients.
CONCLUSION: The strategies based on H. pylori test enjoyed similar symptom resolution, but reduced endoscopic workload and lower 1-yr total costs compared with empirical antisecretory therapy.
(Am J Gastroenterol 2006;101:1200–1208)
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