BMJ 2002;325:281 ( 3 August )

Letters

Management of dyspepsia should be individualised

The first 150 words of the full text of this article appear below.

EDITOR---The papers by Chiba et al and McColl et al show that in the medium term a test and treat approach in dyspepsia can be as effective or better than endoscopically led management. 1 2 However, an individualised approach remains prudent in primary care.

In the long version of the paper by Chiba et al on bmj.com (bmj.com/cgi/content/full/324/7344/1012), 33% of people with a positive result to the initial near patient test were negative on breath testing. Such results are important in populations where the prevalence of Helicobacter pylori is relatively low. Young adults with dyspepsia have a low pre-test probability of being H pylori positive in most developed countries and this, as McColl et al state, alters the investigation strategies used. In such patients a positive result for H pylori might well be a false positive. If the prevalence of H pylori is 25% then 11-12% of positive . . . [Full text of this article]
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Relevant Article

Treating Helicobacter pylori infection in primary care patients with uninvestigated dyspepsia: the Canadian adult dyspepsia empiric treatment---Helicobacter pylori positive (CADET-Hp) randomised controlled trial
Naoki Chiba, Sander J O Veldhuyzen van Zanten, Paul Sinclair, Ralph A Ferguson, Sergio Escobedo, and Eileen Grace
BMJ 2002 324: 1012. [Abstract] [Full Text] [PDF]

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