Document Detail

Managing dyspepsia: what do we know and what do we need to know?
MedLine Citation:
PMID:  9647019     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The conceptual revolution concerning the role of Helicobacter pylori in the pathogenesis of peptic ulcer disease has raised the larger question of how to integrate this new information into the management of patients with dyspepsia. The aim of this research was to critically evaluate current knowledge about dyspepsia and its management. METHODS: Relevant articles on dyspepsia were identified from MEDLINE searches and from the bibliographies of identified articles. Studies that contained information on the prevalence of dyspepsia, endoscopic findings, and evaluations of alternative management strategies were reviewed. RESULTS: By coupling H. pylori serological testing with clinical factors such as age and nonsteroidal antiinflammatory drug use, strategies have been developed that identify patients with organic disease. Although the use of these strategies can reduce the volume of endoscopies, their effects on dyspepsia symptoms are unknown. Computerized decision analysis models have been used to evaluate the cost-effectiveness of alternative strategies. The indirect evidence obtained from these models suggests that empiric therapy, guided by H. pylori testing, may be the preferred approach. However, the models have been hampered by the lack of information concerning dyspepsia symptoms, the primary health outcome of the majority of patients seen in primary practice settings. CONCLUSIONS: Currently, the knowledge needed to integrate H. pylori tests and antimicrobial therapies into the management of patients with dyspepsia in primary practice settings has not been developed. A pressing need exists for a randomized controlled trial to evaluate alternative management strategies. In conducting such a trial, valid, reliable instruments for measuring dyspepsia will be needed.
L Rabeneck; N P Wray; D Y Graham
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  93     ISSN:  0002-9270     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  1998 Jun 
Date Detail:
Created Date:  1998-07-13     Completed Date:  1998-07-13     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  920-4     Citation Subset:  IM    
Department of Veterans Affairs Medical Center, Houston, Texas 77030, USA.
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MeSH Terms
Computer Simulation
Cost-Benefit Analysis
Decision Support Techniques
Dyspepsia / diagnosis*,  therapy*
Helicobacter Infections / diagnosis,  therapy
Helicobacter pylori

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