Clinical-alimentary tractHelicobacter pylori “Test and Treat” or Endoscopy for Managing Dyspepsia: An Individual Patient Data Meta-analysis
Section snippets
Materials and Methods
Meta-analysis at trial level is restricted to pooling the data in an aggregated format reported by the trials. Although contact with authors may provide additional information not reported in the publication, this method has a number of limitations that arise because of the heterogeneity between different trials. This heterogeneity has several sources, which can occur as a result of differences between subject populations, application of interventions, effects measures, coding of resource data,
Results
Five trials were identified comparing management based on a prompt upper GI endoscopy strategy with an H pylori “test and treat” approach for the initial management of dyspepsia. Three trials9, 10 (Dr. Paul Myres, personal communication, May 2004) were registered with the collaborator’s group, of which one10 was published as a full paper. One trial (Myres) had closed early because of poor recruitment, but full follow-up data had been collected on most of the patients recruited, expressly for
Discussion
This study, the first of its kind in this field, has used rigorous methodology to confirm that a prompt endoscopy strategy for the initial management of dyspepsia confers a clinically small, but statistically significant, benefit in terms of patients’ symptom resolution compared with a “test and treat” approach. The explanation for this difference is not clear. We noted an increase in proton pump inhibitor (PPI) prescribing in those patients assigned to prompt endoscopy. However, when a
References (27)
- et al.
Guidelines for the management of Helicobacter pylori infection
Am J Gastroenterol
(1998) - et al.
Initial endoscopy or empirical therapy with or without testing for Helicobacter pylori for dyspepsiaa decision analysis
Gastroenterology
(1996) - et al.
Helicobacter pylori test-and-eradicate versus prompt endoscopy for management of dyspeptic patientsa randomised trial
Lancet
(2000) - et al.
Empirical H2-blocker therapy or prompt endoscopy in management of dyspepsia
Lancet
(1994) - et al.
Canadian Helicobacter pylori Consensus Conference
Can J Gastroenterol
(1998) - et al.
Current concepts in the management of Helicobacter pylori infection—The Maastricht 2-2000 Consensus Report
Aliment Pharmacol Ther
(2002) - et al.
Cost effectiveness of screening for and eradication of Helicobacter pylori in management of dyspeptic patients under 45 years of age
BMJ
(1996) - et al.
Alternative management strategies for patients with suspected peptic ulcer disease
Ann Intern Med
(1995) - et al.
Management strategies for Helicobacter pylori-seropositive patients with dyspepsiaclinical and economic consequences
Ann Intern Med
(1997) - et al.
Approach to treatment of dyspepsia in primary carea randomized trial comparing “test-and-treat” with prompt endoscopy
Arch Intern Med
(2003)
Does initial management of patients with dyspepsia alter symptom response and patient satisfaction? Results from a randomised trial
Gastroenterology
Randomised trial of endoscopy with testing for Helicobacter pylori compared with non-invasive H pylori testing alone in the management of dyspepsia
BMJ
Understanding controlled trialswhat are pragmatic trials?
BMJ
Cited by (0)
Paul Moayyedi has received speaker’s fees and research funds from AstraZeneca, Wyeth Laboratories, and Abbott Laboratories. Brendan C. Delaney has received speaker’s fees from AstraZeneca, Eisai, Wyeth, and AxCan Pharma; holds grants from the MRC and NHS R&D program; and is supported by an NHS R&D Primary Care Career Scientist Award (No. CSA99/008).