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The best management strategy for patients with uninvestigated dyspepsia is unclear. In this network meta-analysis of 15 randomized, controlled trials (6200 adult participants) with follow-up of at least 12 months, researchers compared five strategies: prompt endoscopy, testing for Helicobacter pylori and performing endoscopy in those who tested positive (i.e., “test-and-scope”), testing for H. pylori and eradicating H. pylori in those who tested positive (i.e., “test-and-treat”), empirical acid suppression, and symptom-based management.
Strategies were ranked by effectiveness (i.e., probability of a patient being symptomatic at follow-up). Although test-and-treat was ranked as most effective (followed by prompt endoscopy, test-and-scope, emp…