Upper gastrointestinal endoscopy

BMJ 1995;311:57-58 (1 July)

Letters

Upper gastrointestinal endoscopy

EDITOR,--The editorial by Roger Jones¹ and the guidelines forreferral for endoscopy² both suggest that endoscopy early inthe management of dyspepsia is more cost effective than empiricaltreatment, and an article by Bytzer et al is quoted in supportof this.³ As pointed out in the guidelines, Bytzer's articledisagreed with an Australian study which showed no cost or clinicaladvantage.⁴ In Bytzer's paper, only patients with peptic ulceror reflux oesophagitis who had had endoscopy were given H2 blockers.

In the real world, however, patients with no clear disease onendoscopy continue to use acid suppressants, although at a lowerlevel,⁵ and up to 20% of patients given treatment to eradicatedisease related to Helicobacter pylori continue to take acidsuppressants.⁶ Not surprisingly in Bytzer's paper, the use ofantacids by patients who had endoscopy early and were perhapsdenied H2 blockers by the protocol was . . . [Full text of this article]