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 selecting young dyspeptic patients for gastroscopy as patients who are H. pylori negative and do not exhibit alarm symptoms or ingest non-steroidal anti-inflammatory medication have a low risk of serious organic disease.


OBJECTIVE
To determine if young patients with ulcer-like dyspepsia and found to be H. pylori negative on non-invasive testing could be reassured by this knowledge and not proceed to gastroscopy.


METHODS
One hundred and sixty-one consecutive attendees aged 45 years or less with a presenting complaint of epigastric pain or discomfort were prospectively recruited from open access gastroscopy referrals and gastroenterology 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 advice and also advised to take symptomatic therapy as required. Patients were 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 their dyspepsia score stayed the same or worsened.


RESULTS
Fifty-five H. pylori negative patients were recruited (30 male, mean age 31 years), two patients did not attend subsequent review. Thirty-two (58%) came to gastroscopy. Endoscopic diagnoses included 25 which were normal, three with gastro-oesophageal reflux disease, three with peptic ulcer disease 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 gastroscopies in H. pylori negative patients. Whilst the majority of patients endoscoped had normal findings, seven patients (22%) had pathology. Overall there were significant improvements in dyspepsia and quality of life at 6 month follow-up.
Heaney
A
A
Day Procedure Unit, Royal Victoria Hospital, Belfast, Northern Ireland.
Collins
J S
JS
Tham
T C
TC
Watson
P R
PR
McFarland
J R
JR
Bamford
K B
KB
D000328:Adult; D004415:Dyspepsia / Q000382:microbiology / Q000628:therapy*; D005260:Female; D005773:Gastroscopy / Q000706:statistics & numerical data*; D016481:Helicobacter Infections / Q000175:diagnosis*; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life