Long-term follow-up of empirical treatment or prompt endoscopy for patients with persistent dyspeptic symptoms?
BACKGROUND
There are concerns about the safety and possible high costs of ongoing proton pump inhibitor therapy of empirical management strategies for patients with persistent dyspeptic symptoms.


OBJECTIVE
To compare the long-term results of two treatment strategies: empirical treatment followed by the Helicobacter pylori test and treat strategy (treat and test group) and prompt upper gastrointestinal endoscopy followed by directed medical treatment (endoscopy group).


METHODS
In this study we describe the long-term follow-up data from a previously published randomized clinical trial. At least 6 years after randomization all participating general practitioners and patients were asked to give information about medication use, diagnostic testing, symptoms and quality of life by questionnaire.


RESULTS
Information about a total of 77 out of the 80 patients initially included (96%) was retrieved. Overall, 16 patients from the treat and test group (41%) underwent 18 diagnostic investigations. The 34 patients (100%) from the endoscopy group underwent 38 investigations (P < 0.01). The number of patients of the treat and test group and endoscopy group using acid inhibition therapy was 15 (38%) and 19 (56%), respectively (P = 0.14). There were also no differences in symptom prevalence and quality of life between the groups.


CONCLUSIONS
Treat and test management for patients with dyspeptic symptoms is safe and does not lead to additional diagnostic testing or use of medication when compared to prompt endoscopy.
Laheij
Robert J F
RJ
Department of Gastroenterology, University Hospital Nijmegen, the Netherlands.
van Rossum
Leo G M
LG
Heinen
Nadia
N
Jansen
Jan B M J
JB
D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D004415:Dyspepsia / Q000188:drug therapy / Q000628:therapy*; D005500:Follow-Up Studies; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000188:drug therapy; D016480:Helicobacter pylori; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans
D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists