Objective: To compare a Helicobacter pylori “test and treat” strategy to prompt endoscopy in young Asians with dyspepsia
Design: Randomised, prospective study
Setting: Single (academic) primary care centre
Patients: Uninvestigated dyspeptics aged < 45 years
Interventions: Randomisation to either 13C-urea breath test (UBT) or prompt endoscopy (OGD) and followed up for 12 months
Results: 432 patients (mean age 30 ± 8 years, male 46%, ethnicity: Malays 33.3%, Chinese 30.6%, Indians 34.7%) were randomized to UBT (n=222) and OGD (n=210). 387 (89.6%) patients completed the study. At 12 months, there was no difference in symptom change (measured by the Leeds Dyspepsia Questionnaire) between the two groups but more patients were very satisfied (40.0% vs 21.6%, p < 0.0001) in the OGD group. More additional endoscopy was performed in the UBT group (25 vs 10, p=0.03), but medication consumption was higher in the OGD group (PPI 3.6 ± 8.8 vs 2.0 ± 7.5 weeks, p< 0.001; H2RA 5.3 ± 9.7 vs 3.9 ± 9.2 weeks, p=0.017; prokinetics 1.4 ± 4.7 vs 0.4 ± 2.5 weeks, p< 0.001) and no differences in medical consultation were noted. The median cost of the initial prompt endoscopy approach at 12 months was significantly higher than a 'test and treat' strategy (US$ 179.05 vs US$ 87.10, p<0.0001).
Conclusion: A H pylori 'test and treat' strategy is more cost-effective but less satisfying than prompt endoscopy in the management of young Asian patients with uncomplicated dyspepsia.