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Comparison between empirical prokinetics, Helicobacter test-and-treat and empirical endoscopy in primary-care patients presenting with dyspepsia: A one-year study

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World Journal of Gastroenterology 2006年第31期12卷 5010-5016页

作者： Wayne HC Hu SK Lam Cindy LK Lam WM Wong KF Lam KC Lai YH Wong Benjamin CY Wong Annie OO Chan CK Chan Gabriel M Leung WM Hui Department of Medicine University of Hong Kong Hong Kong China Department of Statistics and Actuarial Science University of Hong Kong Hong Kong China Department of Community Medicine University of Hong Kong Hong Kong China

AIM： To investigate the optimal strategy to treat dyspeptic patients in primary care. METHODS： dyspeptic patients presenting to primary care outpatient clinics were randomly assigned to- （1） empirical endoscopy, （2） H pylori test-and-treat, and （3） empirical prokinetic treatment with cisapride. Early endoscopy was arranged if patients remained symptomatic after 2 wk. Symptom severity, quality-of-life （SF-36） as well as patient preference and satisfaction were assessed. All patients underwent endoscopy by wk 6. patients were followed up for one year. RESULTS： Two hundred and thirty four patients were recruited （163 female, mean age 49）. 46% were H pylori positive. 26% of H pylori tested and 25% of empirical prokinetic patients showed no improvement at wk 2 follow-up and needed early endoscopy. 15% of patients receiving empirical cisapride responded well to treatment but peptic ulcer was the final diagnosis. Symptom resolution and quality-of-life were similar among the groups. Costs for the three strategies were HK$4343, $1771 and $1750 per patient. 66% of the patients preferred to have early endoscopy. CONCLUSION： The three strategies are equally effective. Empirical prokinetic treatment was the least expensive but peptic ulcers may be missed with this treatment. The H pylori test-and-treat was the most cost-effective option .

关键词： Empirical endoscopy dyspeptic patients Hpylori test-and treat

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