Does the ‘test‐and‐treat’ strategy work in primary health care for management of uninvestigated dyspepsia? A prospective two‐year follow‐up study of 1552 patients

Abstract

Background: Although the ‘test‐and‐treat’ strategy is suggested as first‐line therapy for uninvestigated dyspepsia, no large‐scale studies in a real‐life setting are available. Methods: 1552 dyspeptic patients aged between 25 and 60 with no alarm symptoms were recruited to the study. After screening with a ¹³ C‐urea breath test, they were randomized into three treatment arms: Helicobacter pylori‐positive either to eradication therapy with OAM (omeprazole, amoxycillin and metronidazole) (Hp+/erad) or omeprazole 20 mg daily (Hp+/ome) for 10 days, whereas H. pylori‐negative patients (Hp−/ome) were treated with 20 mg omeprazole for 10 days. Gastrointestinal symptoms were registered at baseline at 1 and 2 years on the Gastrointestinal Symptom Rating Scale (GSRS) and quality of life with the Psychological General Well‐Being index (PGWB). Additional visits, referrals for and number of endoscopies and their findings were registered during the 2 years' follow‐up. Results: Of the 1552 patients, 583 were H. pylori‐positive (37.6%), and 288 of these were randomized for omeprazole and 295 to OAM. The Hp−/ome group had fewer general practitioner (GP) contacts (P < 0.0001) than the H. pylori‐positive groups. Eradication therapy significantly improved general well‐being and reduced upper gastrointestinal symptoms: abdominal pain (P = 0.0001), heartburn (P = 0.0061), acid regurgitation (P = 0.003), hunger pain (P = 0.009), especially in Hp+/erad. Peptic ulcer was found in 6.2%, 1.0%, 0.2% in Hp+/ome, Hp−+/erad and Hp−/ome, respectively (P = 0.0007). Only 3 patients (1.0%) developed peptic ulcers in Hp−+/erad, all eradication failures. Conclusions: In uninvestigated dyspepsia, a negative test result for H. pylori reduces the number of GP contacts and endoscopy referrals compared to H. pylori‐positive regardless of eradication therapy. Applied in real life, the test‐and‐treat strategy failed to reduce the number of endoscopies, but significantly reduced peptic ulcer disease and improved dyspeptic symptoms and quality of life.

• Dyspepsia
• endoscopy
• Helicobacter pylori
• urea breath test