Authors' objectives:

This report aims to address the following issues:

The management of uninvestigated dyspepsia in primary care 1. How effective is initial pharmacological therapy? 2. How effective is early endoscopy? 3. How effective is Helicobacter pylori screening before endoscopy in patients with dyspepsia? 4. How effective is H. pylori screening before eradication therapy in patients with dyspepsia? 5. Does subdividing dyspepsia on the basis of symptom patterns predict response to particular therapies? 6. What are the most cost-effective combinations of initial investigation strategy and prescribing for patients? 7. What are the most important strategies to compare in future trials?

Therapy for proven non-ulcer dyspepsia (NUD) 1. How effective is pharmacological therapy? 2. How effective is H. pylori eradication? 3. What is the most cost-effective therapy? 4. What are the most important therapies to compare in the treatment of NUD?

Authors' recommendations: There is still much uncertainty around the management of dyspepsia, both uninvestigated dyspepsia and proven NUD. This review indicates that the treatment for NUD, for which the evidence is most reliable, is H. pylori eradication. The effect is small but cost-effective as the treatment is potentially curative rather than just suppressive. Whether the effect is due to treating latent peptic ulcer disease or some other mechanism, the implication is that patients diagnosed on the basis of a negative endoscopy will benefit from H. pylori eradication. In primary care, the conclusions are much less robust. Proton pump inhibitors (PPIs) are the most effective treatment for undiagnosed dyspepsia and reasonably cost-effective. This is because the case-mix includes patients with peptic ulcer disease and gastro-oesophageal reflux disease, for which PPIs are effective treatments. The relative efficacy of H2-receptor antagonists is uncertain, because of a lack of trials comparing antacids and H2-receptor antagonists and a lack of trials in patients without reflux as a dominant symptom. Although management based on early endoscopy may lead to a small reduction in dyspeptic symptoms, the cost-effectiveness of endoscopy is uncertain. Modelling suggests that, for most patients, endoscopy-based management is not cost-effective as there is little gain in symptom relief and considerable additional cost. Of the empirical strategies, H. pylori test-and-treat is likely to be more cost-effective than endoscopy but well-designed, primary care based trials are needed to compare cost-effectiveness and effects on quality of life with empirical acid suppression.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.hta.ac.uk/1017

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

Copyright: 2000 Queen's Printer and Controller of HMSO