BMJ  2003;327:811 (4 October), doi:10.1136/bmj.327.7418.811-a

Letter

Dyspepsia results may not apply in primary care

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

EDITOR—Manes et al reported their trial of Helicobacter pylori test and treat v initial proton pump inhibitors.¹ Their results in secondary care are encouraging in that eradication treatment for H pylori reduced the relapse of symptoms by 33% compared with a short course of treatment to suppress acid. However, we doubt whether their findings have any relevance to the use of "test and treat" in primary care.

Manes et al used an aggressive investigative strategy of testing, treating, and endoscopy v proton pump inhibitor and endoscopy in patients with dyspepsia who attended a single hospital clinic. All patients in the trial had intensive monthly then two monthly follow up and underwent endoscopy if symptoms recurred after their initial treatment. This would not be usual practice in primary care, where trials have shown that only 25% of young dyspeptic patients undergo endoscopy within a year after consultation.²

In addition, . . . [Full text of this article]

Department of Primary Care and General Practice, University of Birmingham, Birmingham B15 2TT B.C.Delaney@bham.ac.uk

Gastroenterology Unit, City Hospital NHS Trust, Birmingham B18 7QH

Department of Public Health and Epidemiology, University Hospital, Nottingham NG7 2UH

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Empirical prescribing for dyspepsia: randomised controlled trial of test and treat versus omeprazole treatment

Gianpiero Manes, Antonella Menchise, Claudio de Nucci, and Antonio Balzano
BMJ 2003 326: 1118. [Abstract] [Full Text] [PDF]

Treating Helicobacter pylori infection in primary care patients with uninvestigated dyspepsia: the Canadian adult dyspepsia empiric treatmentHelicobacter 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]

Randomised controlled trial of Helicobacter pylori testing and endoscopy for dyspepsia in primary care

B C Delaney, S Wilson, A Roalfe, L Roberts, V Redman, A Wearn, and F D R Hobbs
BMJ 2001 322: 898. [Abstract] [Full Text] [PDF]

Online poll

Find out more here>> and here>>