Evidence relating to test and treat for H.pylori

A study by Heaney and colleagues provides evidence that, in young healthy patients with dyspepsia and H.pylori, a test and treat strategy is more effective than OGD based management (1).

• trial - unblinded, randomised, controlled trial with 12 month follow-up
• patients - < 45 years of age, patients were excluded if there was a history of dysphagia, weight loss, regular use of NSAIDs, gallstone symptoms, symptoms of gastroeosophageal reflux, pregnancy. Also patients were excluded if they had had H.pylori eradication treatment in the previous 2 weeks. 104 patients were recruited with a 96% follow-up
• patients were stratified for alcohol use, tobacco use and sex. Patients were treated were allocated to either empirical eradication therapy or OGD management. In the patients with OGD eradication therapy was given according to the diagnosis. Eradication therapy used in this study was omeprazole 20 mg bd, clarithromycin 250mg bd, tinidazole 500mg bd
• results - at 12 months the patients in the empirical eradication group had less dyspeptic symptoms and improved quality of life in comparison to the OGD group

A more recent study revealed (2) that empirical treatment followed by a test-and-eradicate strategy resulted in fewer diagnostic tests, more symptom relief and lower medical costs compared with prompt upper gastrointestinal radiography or endoscopy in the management of uninvestigated patients with persistent dyspeptic symptoms

Reference:

1. Gut (1999); 45:186-90.
2. Laheij RJ et al (2004). Empirical treatment followed by a test-and-treat strategy is more cost-effective in comparison with prompt endoscopy or radiography in patients with dyspeptic symptoms: a randomized trial in a primary care setting. Fam Pract; 21:238-43.