Comparison between empirical prokinetics, Helicobacter test-and-treat and empirical endoscopy in primary-care patients presenting with dyspepsia: A one-year study
| Autor: | Y H Wong, Kam Chuen Lai, Benjamin C.Y. Wong, Kwok Fai Lam, Chi K. Chan, Wai Man Wong, Wai Mo Hui, S. K. Lam, Annie On-On Chan, Cindy L. K. Lam, Wayne H. C. Hu, Gabriel M. Leung |
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| Předmět: |
Adult
Male Helicobacter pylori - metabolism medicine.medical_specialty Adolescent Peptic Cost-Benefit Analysis H pylori test-and treat Helicobacter Infections - diagnosis Primary care Endoscopy - economics - methods Helicobacter Infections Clinical Research Primary Health Care - methods Internal medicine medicine Outpatient clinic Humans Helicobacter Dyspepsia Aged Dyspeptic patients biology medicine.diagnostic_test Helicobacter pylori Primary Health Care business.industry Gastroenterology Endoscopy General Medicine Middle Aged biology.organism_classification Surgery Cisapride Dyspepsia - diagnosis Test and treat Female Empirical endoscopy business medicine.drug |
| Zdroj: | Scopus-Elsevier |
| Popis: | 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. © 2006 The WJG Press. All rights reserved. published_or_final_version |
| Databáze: | OpenAIRE |
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