Test-and-Treat for H. pylori vs. Acid Suppression for Dyspepsia

Which of two common approaches to initial management of patients with dyspepsia is superior — test-and-treat for Helicobacter pylori infection or empirical acid suppression with a proton-pump inhibitor?

In a randomized U.K. study, investigators enrolled 699 adults who had dyspepsia without alarm symptoms for at least 4 weeks; half were tested for H. pylori (using the ¹³C-urea breath test) and treated based on their results, and half received empirical acid suppression. Test-and-treat patients who were positive for H. pylori infection were offered eradication therapy (1 week of omeprazole/clarithromycin/metronidazole, followed by 3 weeks of omeprazole). Patients who were negative for H. pylori infection were treated with omeprazole for 4 week…