Comparison between empirical prokinetics, Helicobacter test-and-treat and empirical endoscopy in primary-care patients presenting with dyspepsia: a one-year study.
OBJECTIVE
To investigate the optimal strategy to treat dyspeptic patients in primary care.


METHODS
Dyspeptic patients presenting to primary care outpatient clinics were randomly assigned to: (1) empirical endoscopy, (2) H pylori test-and-treat, and (3) empirical prokinetic treatment with cisapride. Early endoscopy was arranged if patients remained symptomatic after 2 wk. Symptom severity, quality-of-life (SF-36) as well as patient preference and satisfaction were assessed. All patients underwent endoscopy by wk 6. Patients were followed up for one year.


RESULTS
Two hundred and thirty four patients were recruited (163 female, mean age 49). 46% were H pylori positive. 26% of H pylori tested and 25% of empirical prokinetic patients showed no improvement at wk 2 follow-up and needed early endoscopy. 15% of patients receiving empirical cisapride responded well to treatment but peptic ulcer was the final diagnosis. Symptom resolution and quality-of-life were similar among the groups. Costs for the three strategies were HK dollar 4343, dollar 1771 and dollar 1750 per patient. 66% of the patients preferred to have early endoscopy.


CONCLUSIONS
The three strategies are equally effective. Empirical prokinetic treatment was the least expensive but peptic ulcers may be missed with this treatment. The H pylori test-and-treat was the most cost-effective option.
Hu
Wayne H C
WH
Department of Medicine, University of Hong Kong, China. hchu@hku.hk
Lam
S K
SK
Lam
Cindy L K
CL
Wong
W M
WM
Lam
K F
KF
Lai
K C
KC
Wong
Y H
YH
Wong
Benjamin C Y
BC
Chan
Annie O O
AO
Chan
C K
CK
Leung
Gabriel M
GM
Hui
W M
WM
D000293:Adolescent; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D004415:Dyspepsia / Q000175:diagnosis*; D004724:Endoscopy / Q000191:economics / Q000379:methods*; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis*; D016480:Helicobacter pylori / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*