PMID- 19821286
OWN - NLM
STAT- MEDLINE
DCOM- 20100127
LR  - 20231223
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
VI  - 2009
IP  - 4
DP  - 2009 Oct 7
TI  - WITHDRAWN: Initial management strategies for dyspepsia.
PG  - CD001961
LID - 10.1002/14651858.CD001961.pub3 [doi]
LID - 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 (H. 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 
      were collected on dyspeptic symptoms, quality of life and use of resources. An 
      individual patient data meta-analysis of health economic data was conducted MAIN 
      RESULTS: Twenty-five papers reporting 27 comparisons were found. Trials comparing 
      proton pump inhibitors (PPI) with antacids (three trials) and histamine 
      H2-receptor antagonists (H2RAs) (three trials), early endoscopy with initial acid 
      suppression (five trials), H. pylori test and endoscope versus usual management 
      (three trials), H. pylori test and treat versus endoscopy (six trials), and test 
      and treat versus acid suppression alone in H. pylori positive patients (four 
      trials), were pooled. PPIs were significantly more effective than both H2RAs and 
      antacids. Relative risks (RR) and 95% confidence intervals (CI) were; for PPI 
      compared with antacid 0.72 (95% CI 0.64 to 0.80), PPI compared with H2RA 0.63 
      (95% CI 0.47 to 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 H. pylori test and treat (OR 0.75, 
      95% CI 0.58 to 0.96), but was not cost effective (mean additional cost of 
      endoscopy US$401 (95% CI $328 to 474). Test and treat may be more effective than 
      acid suppression alone (RR 0.59 95% CI 0.42 to 0.83). AUTHORS' CONCLUSIONS: 
      Proton pump inhibitor drugs (PPIs) are effective in the treatment of dyspepsia in 
      these trials which may not adequately exclude patients with gastro-oesophageal 
      reflux disease (GORD). The relative efficacy of histamine H2-receptor antagonists 
      (H2RAs) and PPIs is uncertain. Early investigation by endoscopy or H. pylori 
      testing may benefit some patients with dyspepsia but is not cost effective as 
      part of an overall management strategy.
FAU - Delaney, Brendan
AU  - Delaney B
AD  - Division of Health and Social Care Research, King's College London, 7th Floor 
      Capital House, 42 Weston Street, London, UK, SE1 3QD.
FAU - Ford, Alex C
AU  - Ford AC
FAU - Forman, David
AU  - Forman D
FAU - Moayyedi, Paul
AU  - Moayyedi P
FAU - Qume, Michelle
AU  - Qume M
LA  - eng
PT  - Journal Article
PT  - Review
PT  - Systematic Review
DEP - 20091007
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. 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
PMC - PMC10734262
EDAT- 2009/10/13 06:00
MHDA- 2010/01/28 06:00
PMCR- 2010/10/07
CRDT- 2009/10/13 06:00
PHST- 2009/10/13 06:00 [entrez]
PHST- 2009/10/13 06:00 [pubmed]
PHST- 2010/01/28 06:00 [medline]
PHST- 2010/10/07 00:00 [pmc-release]
AID - CD001961.pub3 [pii]
AID - 10.1002/14651858.CD001961.pub3 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2009 Oct 7;2009(4):CD001961. doi: 
      10.1002/14651858.CD001961.pub3.