title: Empirical prescribing for dyspepsia: randomised controlled trial of test and treat versus omeprazole treatment.
abstract: OBJECTIVE
  To compare the efficacy of a "Helicobacter pylori test and treat" strategy with that of an empirical trial of omeprazole in the non-endoscopic management by empirical prescribing of young patients with dyspepsia.
  
  
  METHODS
  Randomised controlled trial.
  
  
  METHODS
  Hospital gastroenterology unit.
  
  
  METHODS
  219 patients under 45 years old presenting with dyspepsia without alarm symptoms.
  
  
  METHODS
  Patients received treatment with omeprazole 20 mg (group A) or with a urea breath test followed by an eradication treatment in case of H pylori infection or omeprazole alone in non-infected patients (group B). Lack of improvement or recurrence of symptoms prompted endoscopy.
  
  
  METHODS
  Improvement in symptoms assessed by a dyspepsia severity score every two months; use of medical resources (endoscopic workload and medical consultation); clinical outcome.
  
  
  RESULTS
  96/109 (88%) patients in group A and 61/110 (55%) in group B (P < 0.0001) had endoscopy: in 19 patients in group A and 32 in group B (20/67 infected and 12/43 non-infected) because of no improvement; in 77 further patients in group A and 29 in group B (7 infected and 22 non-infected) because of recurrence of symptoms during follow up. Endoscopy showed peptic ulcers only in group A; oesophagitis occurred significantly more often in group B than in group A. About 80% of examinations were normal in both groups, but nine duodenal scars occurred in group A.
  
  
  CONCLUSIONS
  Eradication treatment allows resolution of symptoms in a large number of patients with dyspepsia and reduces the endoscopic workload. After a trial of omeprazole, symptoms recur in nearly every patient. Such treatment is also likely to mask an appreciable number of peptic ulcers and cases of oesophagitis.
authors.affiliation: Department of Gastroenterology, Cardarelli Hospital, Via Solimena 101, 80129 Naples, Italy. gimanes@tin.it
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Manes
authors.forename: Antonella
authors.initials: A
authors.lastname: Menchise
authors.forename: Claudio
authors.initials: C
authors.lastname: de Nucci
authors.forename: Antonio
authors.initials: A
authors.lastname: Balzano
mesh_terms: D000328:Adult; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D004415:Dyspepsia / Q000188:drug therapy* / Q000382:microbiology; D016099:Endoscopy, Gastrointestinal; D005260:Female; D016481:Helicobacter Infections / Q000150:complications*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use*; D010349:Patient Compliance; D012008:Recurrence
chemical_list: D000897:Anti-Ulcer Agents; D009853:Omeprazole