PMID- 11687004
OWN - NLM
STAT- MEDLINE
DCOM- 20020328
LR  - 20200511
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 3
DP  - 2001
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. Dyspepsia was 
      defined to include both epigastric pain and heartburn. 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: Eighteen papers reporting 20 comparisons were found. Trials comparing 
      proton pump inhibitors (PPI) with antacids (two trials) and H2 receptor 
      antagonists (three trials), early endoscopy with initial acid suppression (five 
      trials), H.pylori 'test and scope' v usual management (three trials) and H.pylori 
      test and treat v. endoscopy (three 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. Initial endoscopy was 
      associated with a small reduction in the risk of recurrent dyspepstic symptoms 
      compared with initial prescribing (RR 0.89 (0.77-1.02). H.pylori test and 
      endoscopy increases costs in primary care, but does not improve symptoms. 
      H.pylori test and eradicate may be as effective as endoscopy- based management 
      and reduces costs, by decreasing the proportion of patients that are endoscoped. 
      Further primary care-based trials are needed to compare 'test and treat' with 
      empirical acid suppression. 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 by endoscopy or H.pylori testing may benefit some 
      patients with dyspepsia. The review will be updated in 2002 with an individual 
      patient data meta-analysis of the economic data, and a subgroup analysis by age 
      and predominant dyspeptic symptom.
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 - Cooner, M K
AU  - Cooner MK
FAU - Moayyedi, P
AU  - Moayyedi P
FAU - Oakes, R
AU  - Oakes R
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
UOF - Cochrane Database Syst Rev. 2000;(2):CD001961. PMID: 10796841
UIN - Cochrane Database Syst Rev. 2003;(2):CD001961. PMID: 12804417
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
MH  - Randomized Controlled Trials as Topic
RF  - 66
EDAT- 2001/11/01 10:00
MHDA- 2002/03/29 10:01
CRDT- 2001/11/01 10:00
PHST- 2001/11/01 10:00 [pubmed]
PHST- 2002/03/29 10:01 [medline]
PHST- 2001/11/01 10:00 [entrez]
AID - CD001961 [pii]
AID - 10.1002/14651858.CD001961 [doi]
PST - ppublish
SO  - Cochrane Database Syst Rev. 2001;(3):CD001961. doi: 10.1002/14651858.CD001961.