H. pylori Test-and-Treat Strategy Best for Dyspepsia
Strategy may change, however, as H. pylori prevalence continues to decrease
THURSDAY, June 29 (HealthDay News) -- Testing for Helicobacter pylori may be the best initial management strategy for patients presenting with dyspepsia, according to a study published in the June issue of the American Journal of Gastroenterology.
Dorte Ejg Jarbol, M.D., Ph.D., from the University of Southern Denmark in Odense, and colleagues conducted a cluster randomized trial to compare the efficacy of three strategies: initial treatment with proton pump inhibitor (PPI) in 222 patients, H. pylori test-and-eradicate in 250 patients, and PPI followed by H. pylori testing if symptoms improved in 250 patients.
While all three strategies improved symptom and quality-of-life scores equally after one year of treatment, the researchers found that the mean use of endoscopies per patient after one year was higher in the PPI group (0.36) than in the test-and-eradicate group (0.28) and the combination group (0.22). They also found H. pylori-positive patients who had their infection eradicated had more days without dyspeptic symptoms, used less antisecretory therapy and were more satisfied than their H. pylori-negative counterparts.
"We are aiming at a moving target when we try to design management strategies for dyspeptic patients," stated the author of an accompanying editorial. "H. pylori testing is certainly still recommendable owing to the long-term benefits, but in many parts of North America and Europe, where Helicobacter prevalence is low and rapidly decreasing, this approach may soon be cost-ineffective as the initial step."