Approach to treatment of dyspepsia in primary care - A randomized trial comparing 'Test-and-treat' with prompt endoscopy
| Autor: | Jan-Mark Götz, Wim J. Sluiter, Anton A. van Zwet, Jacob C. Thijs, Klaas Reenders, Ger T. van de Werf, Jan H. Kleibeuker, Nicolaas L. A. Arents, Marco Oudkerk Pool |
|---|---|
| Přispěvatelé: | Guided Treatment in Optimal Selected Cancer Patients (GUTS) |
| Jazyk: | angličtina |
| Rok vydání: | 2003 |
| Předmět: |
Adult
Male medicine.medical_specialty Abdominal pain Referral Cost effectiveness PERSISTENT DYSPEPSIA Statistics Nonparametric law.invention Helicobacter Infections COST-EFFECTIVENESS Patient satisfaction Quality of life Randomized controlled trial ABDOMINAL-PAIN law HELICOBACTER-PYLORI Internal medicine Gastroscopy GENERAL-PRACTICE Internal Medicine medicine Prevalence Humans Dyspepsia Chi-Square Distribution medicine.diagnostic_test Helicobacter pylori Primary Health Care DRUG-TREATMENT business.industry Primary care physician Middle Aged Surgery Endoscopy Patient Satisfaction MANAGEMENT STRATEGIES Female DECISION-ANALYSIS medicine.symptom FUNCTIONAL DYSPEPSIA business PEPTIC-ULCER |
| Zdroj: | Archives of Internal Medicine, 163(13), 1606-1612. AMER MEDICAL ASSOC |
| ISSN: | 0003-9926 |
| Popis: | Background The value of the "test-and-treat" strategy in the approach to dyspepsia has been evaluated only in a few secondary care studies. Most patients with dyspepsia, however, are treated by their primary care physician. This study evaluated the test-and-treat strategy in primary care. Methods Patients consulting their general practitioners for dyspepsia were randomized to either direct open-access endoscopy withHelicobacter pyloritesting or a test-and-treat strategy byH pyloriserology. In the 12-month follow-up period, any additional treatment or referral for investigations was left at the discretion of the general practitioner. At the end of the study, data were collected concerning the number of endoscopies, changes in symptom severity and quality of life, patient satisfaction, and the use of medical resources. Results Two hundred seventy patients were enrolled (129 who received endoscopy and 141 in the test-and-treat group). The prevalence ofH pyloriinfection was 38.3% and 37.2% in the test-and-treat and endoscopy groups, respectively. In the test-and-treat group, 46 patients (33%) were referred for endoscopy during follow-up. Improvement in symptom severity, quality of life, and patient satisfaction was comparable in both groups. Patients in the test-and-treat group paid more dyspepsia-related visits to their general practitioner (P= .005). Patients in the endoscopy group were more often prescribed proton pump inhibitors (P= .007), whereas patients in the test-and-treat group were more often prescribed prokinetic drugs (P= .005). Conclusions The test-and-treat strategy proved to be as effective and safe as prompt endoscopy. Only a minority of patients were referred for endoscopy after the test-and-treat approach. |
| Databáze: | OpenAIRE |
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