Limited impact on endoscopy demand from a primary care based 'test and treat' dyspepsia management strategy: the results of a randomised controlled trial.
BACKGROUND
Helicobacter pylori testing has been suggested as an alternative to endoscopy for young patients with dyspepsia. Secondary care studies have suggested that demand for endoscopy among this group could be reduced by up to 74%. However, the effect of H. pylori testing in the primary care setting, where the majority of dyspepsia is managed, is unclear.


OBJECTIVE
To determine the effects of providing a H. pylori serology service for GPs upon demand for open access endoscopy.


METHODS
A prospective randomised controlled trial.


METHODS
Forty-seven general practices in Gloucestershire.


METHODS
General practices were stratified by endoscopy referral rate and randomised into two groups. The intervention group was provided with access to H. pylori serology testing and encouraged to use it in place of endoscopy for patients aged under 55 years with dyspepsia. Endpoints were referral for endoscopy and serology use.


RESULTS
There was a significant reduction in referrals for endoscopy in the intervention group compared to the control group: 18.8% (95% confidence interval = 5.0 to 30.6%; P = 0.009).


CONCLUSIONS
Providing GPs with H. pylori serology testing reduced demand for open access endoscopy, but by less than previous studies had predicted.
Shaw
Ian S
IS
Health Protection Agency Primary Care Unit, London. Ian.Shaw@glos.nhs.uk
Valori
Roland M
RM
Charlett
André
A
McNulty
Cliodna A M
CA
D000328:Adult; D004415:Dyspepsia / Q000097:blood / Q000382:microbiology*; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data*; D005194:Family Practice / Q000458:organization & administration; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis*; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data