title: Approach to treatment of dyspepsia in primary care: a randomized trial comparing "test-and-treat" with prompt endoscopy.
abstract: BACKGROUND
  The value of the "test-and-treat" strategy in the approach to dyspepsia has been evaluated only in a few secondary care studies. Most patients with dyspepsia, however, are treated by their primary care physician. This study evaluated the test-and-treat strategy in primary care.
  
  
  METHODS
  Patients consulting their general practitioners for dyspepsia were randomized to either direct open-access endoscopy with Helicobacter pylori testing or a test-and-treat strategy by H pylori serology. In the 12-month follow-up period, any additional treatment or referral for investigations was left at the discretion of the general practitioner. At the end of the study, data were collected concerning the number of endoscopies, changes in symptom severity and quality of life, patient satisfaction, and the use of medical resources.
  
  
  RESULTS
  Two hundred seventy patients were enrolled (129 who received endoscopy and 141 in the test-and-treat group). The prevalence of H pylori infection was 38.3% and 37.2% in the test-and-treat and endoscopy groups, respectively. In the test-and-treat group, 46 patients (33%) were referred for endoscopy during follow-up. Improvement in symptom severity, quality of life, and patient satisfaction was comparable in both groups. Patients in the test-and-treat group paid more dyspepsia-related visits to their general practitioner (P =.005). Patients in the endoscopy group were more often prescribed proton pump inhibitors (P =.007), whereas patients in the test-and-treat group were more often prescribed prokinetic drugs (P =.005).
  
  
  CONCLUSIONS
  The test-and-treat strategy proved to be as effective and safe as prompt endoscopy. Only a minority of patients were referred for endoscopy after the test-and-treat approach.
authors.affiliation: Regional Public Health Laboratory, Groningen/Drenthe, The Netherlands.
authors.forename: Nicolaas L A
authors.initials: NL
authors.lastname: Arents
authors.forename: Jacob C
authors.initials: JC
authors.lastname: Thijs
authors.forename: Anton A
authors.initials: AA
authors.lastname: van Zwet
authors.forename: Marco
authors.initials: M
authors.lastname: Oudkerk Pool
authors.forename: Jan-Mark
authors.initials: JM
authors.lastname: Gotz
authors.forename: Ger T
authors.initials: GT
authors.lastname: van de Werf
authors.forename: Klaas
authors.initials: K
authors.lastname: Reenders
authors.forename: Wim J
authors.initials: WJ
authors.lastname: Sluiter
authors.forename: Jan H
authors.initials: JH
authors.lastname: Kleibeuker
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D004415:Dyspepsia / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000188:drug therapy; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D015995:Prevalence; D011320:Primary Health Care / Q000379:methods*; D018709:Statistics, Nonparametric