Abstract | OBJECTIVE: To compare the efficacy of a "Helicobacter pylori test and treat" strategy with that of an empirical trial of omeprazole in the non-endoscopic management by empirical prescribing of young patients with dyspepsia. DESIGN: Randomised controlled trial. SETTING: Hospital gastroenterology unit. PARTICIPANTS: 219 patients under 45 years old presenting with dyspepsia without alarm symptoms. INTERVENTION: Patients received treatment with omeprazole 20 mg (group A) or with a urea breath test followed by an eradication treatment in case of H pylori infection or omeprazole alone in non-infected patients (group B). Lack of improvement or recurrence of symptoms prompted endoscopy. MAIN OUTCOME MEASURES: Improvement in symptoms assessed by a dyspepsia severity score every two months; use of medical resources (endoscopic workload and medical consultation); clinical outcome. RESULTS: 96/109 (88%) patients in group A and 61/110 (55%) in group B (P < 0.0001) had endoscopy: in 19 patients in group A and 32 in group B (20/67 infected and 12/43 non-infected) because of no improvement; in 77 further patients in group A and 29 in group B (7 infected and 22 non-infected) because of recurrence of symptoms during follow up. Endoscopy showed peptic ulcers only in group A; oesophagitis occurred significantly more often in group B than in group A. About 80% of examinations were normal in both groups, but nine duodenal scars occurred in group A. CONCLUSIONS: Eradication treatment allows resolution of symptoms in a large number of patients with dyspepsia and reduces the endoscopic workload. After a trial of omeprazole, symptoms recur in nearly every patient. Such treatment is also likely to mask an appreciable number of peptic ulcers and cases of oesophagitis.
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Authors | Gianpiero Manes, Antonella Menchise, Claudio de Nucci, Antonio Balzano |
Journal | BMJ (Clinical research ed.)
(BMJ)
Vol. 326
Issue 7399
Pg. 1118
(May 24 2003)
ISSN: 1756-1833 [Electronic] England |
PMID | 12763982
(Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial)
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Chemical References |
- Anti-Ulcer Agents
- Omeprazole
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Topics |
- Adult
- Anti-Ulcer Agents
(therapeutic use)
- Dyspepsia
(drug therapy, microbiology)
- Endoscopy, Gastrointestinal
- Female
- Helicobacter Infections
(complications)
- Helicobacter pylori
- Humans
- Male
- Middle Aged
- Omeprazole
(therapeutic use)
- Patient Compliance
- Recurrence
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