Clinical ResearchDyspepsia management in primary care: A decision analysis of competing strategies☆
Section snippets
Materials and methods
Decision analysis is a quantitative method for estimating the financial costs and clinical outcomes of alternative management strategies under conditions of uncertainty. Using decision analysis software,58 we evaluated the cost-effectiveness of 4 sequential empiric strategies for patients with dyspepsia (Figure 1). One pair of strategies begins with H. pylori testing, followed by either endoscopy or a PPI trial for nonresponders, whereas the other pair begins with a PPI trial, followed by
Results
We estimated the potential clinical and economic impact of implementing the 4 alternative strategies in separate cost-effectiveness and cost-utility analyses (Tables 5 and 6).The PPI→EGD strategy generated the lowest cost per patient, $1628, compared with $1902 for the strategy supported by current guidelines (T&T→EGD). The T&T→PPI→EGD strategy cost $1680 per patient, and the PPI→T&T→EGD strategy cost $1788 per patient. The T&T→PPI→EGD and PPI→T&T→EGD strategies were most effective in both
Discussion
This analysis of alternative management strategies for uninvestigated dyspepsia suggests that the current guidelines may not be the most cost-effective approach. Compared with the current guidelines, interposing a 6-week PPI trial between test and treat and upper endoscopy may improve symptomatic relief at 1 year while reducing costs by substantially minimizing the endoscopic burden. Our analysis reveals that the use of PPI therapy before endoscopy may serve as a filter to identify patients who
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2023, Clinical Gastroenterology and HepatologyThe use of Benincasa hispida for the treatment of uninvestigated dyspepsia: Preliminary results of a non-randomised open label pilot clinical trial
2015, Advances in Integrative MedicineCitation Excerpt :An empiric proton pump inhibitor (PPI) trial will treat the most frequent causes of dyspepsia including GERD, medication-induced gastritis, and peptic ulcers, thus minimising the need for costly and invasive testing and used as first choice in the management of dyspepsia [24,25]. Two independent cost-effectiveness analyses found that empiric PPI trial was superior to ‘test and treat’ when treating a dyspeptic population having a low prevalence of H. pylori infection [26,27]. However long-term use of PPIs lead to hypergastrinaemia in most patients due to interaction of drug with H. Pylori.
Current Medical Treatments of Dyspepsia and Irritable Bowel Syndrome
2010, Gastroenterology Clinics of North AmericaCitation Excerpt :In populations with a low H pylori prevalence, empiric antisecretory therapy (a PPI for 1 to 2 months) is the preferred option. Those who fail to respond to these initial approaches, and probably also those with symptom recurrence after stopping antisecretory therapy, should undergo endoscopy, although the yield is likely to be low.31,32,33 Lifestyle (avoiding caffeine, alcohol, and NSAIDs) and dietary (eating more frequent smaller meals and avoiding fatty or spicy meals) measures are usually prescribed to FD patients but, due to lack of studies, there is no firm evidence of benefit.
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