Article Text

PDF
JournalScan

Statistics from Altmetric.com

DIAMONDS ARE A DYSPEPTICS BEST FRIEND?

▸ van Marrewijk CJ, Mujakovic S, Fransen GAJ, . Effect and cost-effectiveness of step-up versus step-down treatment with antacids, H2-receptor antagonists, and proton pump inhibitors in patients with new onset dyspepsia (DIAMOND study): a primary-care-based randomised controlled trial. Lancet 2009;373:215–25.

The initial management of uninvestigated dyspepsia has been the subject of numerous pragmatic randomised controlled trials over the last 15 years. Individual patient data meta-analyses of these trials have demonstrated that prompt endoscopy is superior to Helicobacter pylori “test and treat” in terms of symptom relief, but is not cost-effective, and that there is little to choose between “test and treat” and empirical acid-suppression therapy (AST) with a proton pump inhibitor (PPI), in terms of both symptoms and costs. Now van Marrewijk and colleagues demonstrate that first-line AST does not necessarily mean a PPI.

Subjects with new-onset dyspepsia were recruited in primary care and randomised to receive 1 month of AST either as step-up from antacid to H2-receptor antagonist (H2RA) to PPI (if symptoms were not adequately relieved or relapsed), or step-down with the reverse approach applied. If therapy was a success, it was …

View Full Text

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.