Managing Dyspepsia with "Test and Treat" Ranked Best Strategy

By Joe Elia

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM

Previously uninvestigated dyspepsia seems better managed by testing for Helicobacter pylori and subsequent treatment than by other common strategies, according to a network meta-analysis in The BMJ. (Network meta-analysis enables indirect comparisons among treatments not directly compared with each other.)

Investigators examined outcomes in 15 randomized trials encompassing more than 6000 adult patients; the authors compared five management strategies:

• Prompt endoscopy

• Test for H. pylori, followed by endoscopy after positive findings

• "Test and treat" (for the presence of H. pylori)

• Empirical acid suppression

• Symptom-based management

The approach resulting in the lowest risk of remaining symptomatic by the trials' final follow-up was "test and treat," with a relative risk of 0.89. That strategy just beat out prompt endoscopy (RR, 0.90). However, no strategy was clearly superior to any other.

Prompt endoscopy gained the highest patient-satisfaction ratings; however, the authors point to the high costs involved with that approach.