PMID- 10796841
OWN - NLM
STAT- MEDLINE
DCOM- 20000706
LR  - 20181221
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 2
DP  - 2000
TI  - Initial management strategies for dyspepsia.
PG  - CD001961
AB  - BACKGROUND: This review considers management strategies (combinations of initial 
      investigation and empirical treatments) for dyspeptic patients. OBJECTIVES: To 
      determine the effectiveness, acceptability, and cost effectiveness of the 
      following initial management strategies for patients presenting with dyspepsia 
      (a) initial pharmacological therapy (including endoscopy for treatment failures) 
      (b) early endoscopy (c) testing for Helicobacter pylori and endoscope only those 
      positive (d) H.pylori eradication therapy with or without prior testing. SEARCH 
      STRATEGY: Trials were located through electronic searches and extensive contact 
      with trialists. SELECTION CRITERIA: All randomised controlled trials of dyspeptic 
      patients presenting in primary care. DATA COLLECTION AND ANALYSIS: Data was 
      collected on dyspeptic symptoms, quality of life and use of resources. MAIN 
      RESULTS: Ten papers reporting 12 comparisons were found. Trials comparing proton 
      pump inhibitors (PPI) with antacids (2 trials) and H2 receptor antagonists (3 
      trials), and of early endoscopy compared with initial acid suppression (3 trials) 
      were pooled. PPIs were significantly more effective than both H2RA s and 
      antacids. Relative risks (RR) and 95% CI were, for PPI: antacid 0.72 (0.64-0.80), 
      PPI: H2RA 0.63 (0.47-0.85). Results for other drug comparisons were either absent 
      or inconclusive. Early endoscopy was not more effective than initial prescribing 
      (RR 0.90 (0.77-1.04), but current studies lack power. No eligible trials of 
      H.pylori test and endoscopy or test and eradicate were found. REVIEWER'S 
      CONCLUSIONS: PPIs are effective in the treatment of dyspepsia in these trials 
      which may not adequately exclude patients with gastro-oesophageal reflux disease. 
      The relative efficacy of H2RA and PPI is uncertain. Early investigation may 
      benefit some patients with dyspepsia. The review will be updated shortly with 
      several large trials that have recently been completed.
FAU - Delaney, B C
AU  - Delaney BC
AD  - Department of Primary Care and General Practice, Division of Primary Care, Public 
      and Occupational Health, The Medical School, Edgbaston, Birmingham, West 
      Midlands, UK, B15 2TT. b.c.delaney@bham.ac.uk
FAU - Innes, M A
AU  - Innes MA
FAU - Deeks, J
AU  - Deeks J
FAU - Wilson, S
AU  - Wilson S
FAU - Oakes, R
AU  - Oakes R
FAU - Moayyedi, P
AU  - Moayyedi P
FAU - Hobbs, F D
AU  - Hobbs FD
FAU - Forman, D
AU  - Forman D
LA  - eng
PT  - Journal Article
PT  - Review
PT  - Systematic Review
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Gastrointestinal Agents)
SB  - IM
UIN - Cochrane Database Syst Rev. 2001;(3):CD001961. PMID: 11687004
MH  - Anti-Bacterial Agents/therapeutic use
MH  - Dyspepsia/drug therapy/microbiology/*therapy
MH  - Gastrointestinal Agents/therapeutic use
MH  - Gastroscopy
MH  - Helicobacter Infections/diagnosis/drug therapy
MH  - Helicobacter pylori
MH  - Humans
RF  - 14
EDAT- 2000/05/05 09:00
MHDA- 2000/07/08 11:00
CRDT- 2000/05/05 09:00
PHST- 2000/05/05 09:00 [pubmed]
PHST- 2000/07/08 11:00 [medline]
PHST- 2000/05/05 09:00 [entrez]
AID - CD001961 [pii]
AID - 10.1002/14651858.CD001961 [doi]
PST - ppublish
SO  - Cochrane Database Syst Rev. 2000;(2):CD001961. doi: 10.1002/14651858.CD001961.