PMID- 12804417
OWN - NLM
STAT- MEDLINE
DCOM- 20030728
LR  - 20190622
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 2
DP  - 2003
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: Twenty papers reporting 23 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), H.pylori 
      test and treat v. endoscopy (four trials), and test and treat v. acid suppression 
      alone in H.pylori positive patients (two trials), were pooled. PPIs were 
      significantly more effective than both H2RAs 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 
      dyspeptic 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. 'Test and treat' may be more effective than acid suppression alone, 
      RR 0.59 (0.42-0.83). 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 2004 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, Primary Care and Clinical 
      Sciences Building, The University of Birmingham, Edgbaston, Birmingham, West 
      Midlands, UK, B15 2TT. b.c.delaney@bham.ac.uk
FAU - Moayyedi, P
AU  - Moayyedi P
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. 2001;(3):CD001961. PMID: 11687004
UIN - Cochrane Database Syst Rev. 2005;(4):CD001961. PMID: 16235292
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  - 75
EDAT- 2003/06/14 05:00
MHDA- 2003/07/29 05:00
CRDT- 2003/06/14 05:00
PHST- 2003/06/14 05:00 [pubmed]
PHST- 2003/07/29 05:00 [medline]
PHST- 2003/06/14 05:00 [entrez]
AID - 10.1002/14651858.CD001961 [doi]
PST - ppublish
SO  - Cochrane Database Syst Rev. 2003;(2):CD001961. doi: 10.1002/14651858.CD001961.