Meta-analysis : Helicobacter pylori'test and treat' compared with empirical acid suppression for managing dyspepsia

• Published in: Alimentary pharmacology & therapeutics Vol. 28; no. 5; pp. 534 - 544
• Main Authors: FORD, A. C, MOAYYEDI, P, JARBOL, D. E, LOGAN, R. F. A, DELANEY, B. C
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell 01-09-2008
• Subjects: Anti-Ulcer Agents - administration & dosage; Anti-Ulcer Agents - economics; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Biological and medical sciences; Cost-Benefit Analysis; Digestive system; Dyspepsia - drug therapy; Dyspepsia - economics; Dyspepsia - microbiology; Endoscopy, Gastrointestinal - methods; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Helicobacter; Helicobacter Infections - diagnosis; Helicobacter Infections - drug therapy; Helicobacter Infections - economics; Helicobacter pylori; Human bacterial diseases; Humans; Infectious diseases; Male; Medical sciences; Other diseases. Semiology; Patient Satisfaction - economics; Pharmacology. Drug treatments; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Treatment Outcome; Infection; Treatment; Spirillales; Acids; Helicobacter pylori; Dyspepsia; Spirillaceae; Bacteriosis; Bacteria; Digestive diseases; Comparative study; Metaanalysis
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/j.1365-2036.2008.03784.x

Which of Helicobacter pylori'test and treat' or empirical acid suppression should be preferred for the initial management of uncomplicated dyspepsia is controversial. Aim To conduct an individual patient data meta-analysis of randomized controlled trials (RCTs) of 'test and treat' vs. empirical acid suppression in adults with uncomplicated dyspepsia in primary care.
Investigators provided original data sets for analysis. Effect of management strategy on symptom status and dyspepsia-related resource use at 12-month follow-up was examined by pooling symptom and cost data to obtain relative risk (RR) of remaining symptomatic at 12 months and weighted mean difference (WMD) in costs between the two strategies with 95% confidence intervals (CI).
We identified three eligible RCTs containing 1547 patients, 791 (51%) of whom were assigned to 'test and treat'. There was no difference detected in symptom-cure at 12 months (RR = 0.99; 95% CI: 0.95-1.03). There was a nonsignificant trend towards cost-savings with 'test and treat' (WMD in costs = - 28.91 pound; 95% CI: - 68.48 pound to 10.65 pound).
There was little difference in symptom-resolution or costs between the two strategies. A combination of patient and physician preference should determine the initial approach to the management of uncomplicated dyspepsia.