Empirical H2-blocker therapy or prompt endoscopy in management of dyspepsia

Bytzer, Peter; Hansen, Jane Møller; Muckadell, Ove B Schaffalitzky de

doi:10.1016/s0140-6736(94)92023-0

Cited by 249 publications

(219 citation statements)

References 20 publications

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“…Data on global improvement from four trials 116,138,140,148 were pooled (Figure 4), as the Omega study was non-randomised 149 and the early barium meal study 150 was not considered to be an equivalent intervention to early endoscopy. The four RCTs of early endoscopy and empirical prescribing included 1127 patients and showed a non-statistically significant pooled RR reduction of 11% (95% CI, 22% reduction to 1% increase), Z = -1.77, p = 0.15; heterogeneity test Q = 1.43, df = 3, p = 0.70.…”

Section: Interventions In Dyspepsia In Primary Carementioning

confidence: 99%

“…116 Patients with alarm symptoms, or use of acid suppression in the previous 2 months were excluded. A total of 414 patients were randomised at the endoscopy unit to either early endoscopy or 4 weeks' treatment with ranitidine, 150 mg twice daily.…”

Section: 140mentioning

confidence: 99%

“…Duggan and colleagues 138 found no significant difference in symptoms, although more patients undergoing endoscopy were 'improved' than those receiving empirical PPI (66% versus 60%). The Birmingham study 140 found a significant improvement in symptom score for dyspepsia with early endoscopy.Data on global improvement from four trials 116,138,140,148 were pooled (Figure 4), as the Omega study was non-randomised 149 and the early barium meal study 150 was not considered to be an equivalent intervention to early endoscopy. The four RCTs of early endoscopy and empirical prescribing included 1127 patients and showed a non-statistically significant pooled RR reduction of 11% (95% CI, 22% reduction to 1% increase), Z = -1.77, p = 0.15; heterogeneity test Q = 1.43, df = 3, p = 0.70.…”

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confidence: 99%

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The management of dyspepsia: a systematic review.

Delaney

Moayyedi²,

Deeks³

et al. 2000

Health Technology Assessment

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Section: Interventions In Dyspepsia In Primary Carementioning

confidence: 99%

Section: 140mentioning

confidence: 99%

mentioning

confidence: 99%

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The management of dyspepsia: a systematic review.

Delaney

Moayyedi²,

Deeks³

et al. 2000

Health Technology Assessment

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“…6,7 In both situations, however, patients whose symptoms recur or fail to respond to therapy require further investigation or referral.…”

Section: Introductionmentioning

confidence: 99%

Lansoprazole 30 mg daily versus ranitidine 150 mg b.d. in the treatment of acid‐related dyspepsia in general practice

Jones¹,

Baxter²

1997

Aliment Pharmacol Ther

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Aim: To compare lansoprazole 30 mg daily with ranitidine 150 mg b.d. in the treatment of acid‐related dyspepsia in general practice. Methods: In a double‐blind, parallel group, randomized, multicentre study conducted in 32 general practices in the UK, 213 patients were randomized to receive lansoprazole 30 mg daily, and 219 to receive ranitidine 150 mg b.d., for 4 weeks. All patients had experienced symptoms of reflux‐like or ulcer‐like dyspepsia on at least 4 of the 7 days prior to the study; 75% had experienced dyspepsia in the past, and 74 of the lansoprazole patients and 77 of the ranitidine patients had documented histories of acid‐related disorders, investigated by either radiology or endoscopy. Results: After 2 weeks 55% of the lansoprazole patients and 33% of the ranitidine group were symptom‐free (P = 0.001, χ2 = 7.12) with corresponding 4‐week figures of 69% and 44%, respectively (P = 0.001, χ2 = 18.03). Similar figures were found at both 2 and 4 weeks for daytime and night‐time heartburn and epigastric pain scores; in the lansoprazole group, at 4 weeks, 80% of patients were free of daytime heartburn and 81% of night‐time epigastric pain, compared with 55% (P = 0.001, χ2 = 15.44) and 65% (P = 0.01, χ2 = 6.10) in the ranitidine group. Conclusion: Superior symptom relief for patients presenting with ulcer‐like and reflux‐like symptoms in general practice is provided by lansoprazole 30 mg daily compared with ranitidine 150 mg twice daily.

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“…About 4% of the population consult a general practitioner (GP) each year because of dyspepsia (1), and treatment of these patients varies between empirical treatment (2 Á/4) and prompt endoscopy (5). If the dyspeptic complaint is combined with any symptom, indicating a possible serious disease Á/ a so-called ''alarm'' symptom Á/ investigation should be carried out promptly (6,7).…”

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confidence: 99%