Test-and-eradicate scheme for Helicobacter pylori is as safe and efficient as prompt endoscopyHelicobacter pylori test-and eradicate versus prompt endoscopy for management of dyspeptic patients: a randomised trial.
- Moayyedi, Paul
- Lassen, AT
- Pedersen, FM
- Bytzer, P
- de Muckadell, OBS
BACKGROUND
Some advocate the use of early endoscopy to assess all patients with dyspepsia. But non-invasive testing and eradication therapy for H. pylori may be more cost-effective.
OBJECTIVE
To compare the efficiency and safety of screening and eradication therapy for H. pylori with prompt endoscopy for dyspepsia.
SETTING
Odense, Denmark.
METHOD
Randomised controlled trial.
LITERATURE REVIEW
No explicit strategy; 30 references.
PARTICIPANTS
Five hundred people with dyspepsia.
INTERVENTION
H. pylori testing and eradication therapy programme or endoscopy. The H. pylori group was offered endoscopy if symptoms had not improved at follow-up.
OUTCOMES
Symptoms; resource use; patient satisfaction; reported quality of life based on interviews at baseline, 1 month and 1 year follow-ups.
MAIN RESULTS
28% were infected with H. pylori. At 1 year there were no differences between the two groups in terms of symptoms; quality of life; numbers of sick days; or hospital or GP visits. H. pylori treatment was as safe as early endoscopy: 91% of all peptic ulcers were treated with eradication therapy or subsequently identified by endoscopy. However, in the test-and-eradicate group, 12% were dissatisfied with treatment management compared with 4% in the endoscopy group (P = 0.013).
AUTHORS' CONCLUSIONS
If access to endoscopy is restricted by waiting lists, H. pylori screening and eradication strategies are a viable alternative. These are as safe and efficient as endoscopies, although patients are less satisfied. As the test-and-eradicate strategy may miss gastric cancer, it should be restricted to younger people without gastric cancer symptoms.