Dyspepsie in de huisartspraktijk: serologisch onderzoek naar Helicobacter pylori versus gastroscopie; een gerandomiseerd klinisch onderzoek

To determine if in patients visiting a GP practice with gastric symptoms, it is safe and cost-effective to examine them for Helicobacter pylori and if test results are positive either to treat them or to refer them immediately for gastroscopy for H. pylori testing, and then starting treatment if necessary.

Design

Randomized.

Method

Patients consulting their GP for dyspepsia in the period 1 August 1998-30 September 2001 were randomized to either direct open-access endoscopy with H. pylori testing or a ‘test-and-treat’ strategy based on H. pylori serology. All patients found to be H. pylori positive received eradication therapy. In the following 12 months any additional treatment or investigations were determined by the GP. During and at the end of the study, data were collected from both groups concerning symptom severity, quality of life, patient satisfaction and the use of medical resources.

Results

A total of 270 patients were enrolled: 129 endoscopy and 141 ‘test-and-treat’ patients. The average ages were 44 and 47 years respectively and there were 129 men and 141 women. The prevalence of H. pylori infection was 37 and 38 respectively. In the ‘test-and-treat’ group, 46 patients (33) were referred for endoscopy during follow-up. Improvement in symptom severity, quality of life and patient satisfaction were comparable in both groups. Patients in the ‘test-and-treat’ group paid more dyspepsia-related visits to their GP (p = 0.005) and were more frequently prescribed prokinetic drugs (p = 0.005). Patients in the endoscopy group were more often prescribed proton pump inhibitors (p = 0.007).

Conclusion

The ‘test-and-treat’ strategy was safe and as effective as prompt endoscopy. After the ‘test-and-treat’ approach a third of the patients were referred for endoscopy.