Bmj Usa: Editorial

Bugs, drugs, and dyspepsia in primary care

BMJ 2003; 327 doi: (Published 19 November 2003) Cite this as: BMJ 2003;327:E116
  1. Nimish B Vakil (, professor,
  2. Dino Vaira, professor
  1. University of Wisconsin Medical School, Madison, WI and Marquette University College of Health Sciences, Milwaukee WI
  2. University of Bologna, Bologna, Italy.

    The role of “test and treat” has its limits

    This article originally appeared in BMJ USA

    Dyspepsia is defined as pain or discomfort centered in the upper abdomen, and it is estimated that 2–6% of patients presenting to family physicians have dyspepsia as their presenting complaint.1 2 Two articles in this issue (BMJ USA p 319 and p 324) provide further proof that non-invasive testing for Helicobacter pylori, followed by treatment (the “test and treat” strategy) of those who test positive, is effective in alleviating symptoms, reducing the need for endoscopic investigations, and decreasing the overall cost of managing this common condition.

    Until recently, the diagnostic test for H pylori recommended for use in primary care was serology. This low-cost test is widely available and is inexpensive, allowing primary care physicians to perform H pylori testing in their offices. As the prevalence of H pylori has fallen in developed countries, the predictive value of the serologic test for H pylori has declined along with the …

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