Test-and-Treat or Endoscopy for Dyspepsia?

In multiple studies, researchers have demonstrated a small beneficial effect of Helicobacter pylori eradication in patients with nonulcer dyspepsia. These findings have led to the recommendation that patients should be tested for H. pylori infection, and treated if infected, prior to other dyspepsia evaluations. Cost-effectiveness models have suggested that this approach reduces costs of care by avoiding endoscopies. Recently, several groups have compared the effectiveness of the test-and-treat strategy with that of early endoscopy in real clinical situations. These trials were small, which made definitive results difficult to obtain.

To address this issue, these authors combined the results of five trials (1924 patients) from northern Europ…