Initial management strategies for dyspepsia

Delaney, Brendan; Ford, Alex; Forman, David; Martin, Paul; Qume, Michelle

doi:10.1002/14651858.cd001961

Cited by 99 publications

(42 citation statements)

References 62 publications

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“…The low prevalence of cancer in this population and the high rate of irrelevant findings on endoscopy have encouraged the use of empirical treatment (H pylori eradication or a cycle with proton pump inhibitors) before performing an invasive and relatively costly procedure (upper endoscopy with biopsies). A Cochrane Collaboration review showed that, in the absence of alarm symptoms, the test-and-treat strategy is more effective than an initial endoscopy and empiric use of proton pump inhibitors (39) . The review also showed that the test-and-treat strategy was cheaper than the initial endoscopy.…”

Section: Statementmentioning

confidence: 99%

3rd BRAZILIAN CONSENSUS ON Helicobacter pylori

Coelho

Maguinilk

Zaterka³

et al. 2013

Arq. Gastroenterol.

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Significant progress has been obtained since the Second Brazilian Consensus Conference on Helicobacter pylori Infection held in 2004, in São Paulo, SP, Brazil, and justify a third meeting to establish updated guidelines on the current management of H. pylori infection. The Third Brazilian Consensus Conference on H pylori Infection was organized by the Brazilian Nucleus for the Study of Helicobacter, a Department of the Brazilian Federation of Gastroenterology and took place on April 12-15, 2011, in Bento Gonçalves, RS, Brazil. Thirty-one delegates coming from the five Brazilian regions and one international guest, including gastroenterologists, pathologists, epidemiologists, and pediatricians undertook the meeting. The participants were allocated in one of the five main topics of the meeting: H pylori, functional dyspepsia and diagnosis; H pylori and gastric cancer; H pylori and other associated disorders; H pylori treatment and retreatment; and, epidemiology of H pylori infection in Brazil. The results of each subgroup were submitted to a final consensus voting to all participants. Relevant data were presented, and the quality of evidence, strength of recommendation, and level of consensus were graded. Seventy per cent and more votes were considered as acceptance for the final statement. This article presents the main recommendations and conclusions to guide Brazilian doctors involved in the management of H pylori infection.

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Section: Statementmentioning

confidence: 99%

3rd BRAZILIAN CONSENSUS ON Helicobacter pylori

Coelho

Maguinilk

Zaterka³

et al. 2013

Arq. Gastroenterol.

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“…Pooled results from five trials (1412 patients) that compare H. pylori test and treat for dyspepsia with prompt endoscopy show that there is no clinically significant difference in outcome between H. pylori test and treat for dyspepsia and endoscopy-based management. 5 The low but not insignificant morbidity (one in 200) and mortality (one in 2000) of endoscopy should also be emphasized. 18 All primary care practitioners need to be made aware of the tests available, the benefits and the cost-effectiveness of non-invasive H. pylori tests in patients with uninvestigated dyspepsia without alarm symptoms, and the NICE dyspepsia guidance (C. A. M. McNulty, E. Freeman, D. Delaney, personal communication).…”

Section: Implications For Laboratories and Pctsmentioning

confidence: 99%

“…3,4 Test and treat for H. pylori is cost-effective in patients with uninvestigated dyspepsia, as it reduces demands for endoscopy. 5,6 However, little is known about how many H. pylori tests are performed in primary care, whether the use of the laboratory serology service varies, and what factors prompt GPs to use particular tests. The aims of this study were to determine the variation in submission of H. pylori serology tests, from rural, urban and inner-city general practices in two geographical locations, to laboratories in the UK and to explore, using qualitative methods, the reasons for any variation.…”

Section: Introductionmentioning

confidence: 99%

Variation in the use of H. pylori tests in UK general practice – a qualitative study

McNulty

Freeman

Bowen

et al. 2005

Aliment Pharmacol Ther

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SUMMARYBackground: Although serology is the main Helicobacter pylori test used by general practitioners in the UK, there is no information available on variation in requesting rates. Aim: To explore the reasons for any variation in H. pylori serology testing by general practices in the UK using qualitative methods. Methods: Serology requesting rates were determined using laboratory and population data. Staff from randomly selected practices in the lowest and highest quintiles of testing attended focus groups to discuss the management of H. pylori and dyspepsia. Transcribed data were analysed using an interpretative phenomenological approach. Results: Serology submission varied 600-fold (0.1-59/ 1000 population/year) and H. pylori positivity rate

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“…A Cochrane meta-analysis reported that PPIs are more effective than H 2 receptor blockers (RR 0.63, 95%CI 0.47 to 0.85) and anti-acids (RR 0.72, 95%CI 0.64 to 0.80). [4] However, the DIAMOND study compared step-up (anti-World J Emerg Med, Vol 7, No 1, 2016 acids, H 2 RA and PPIs respectively) and step-down strategies (reverse of the step-up strategy) in patients with dyspepsia in primary care patients and showed that there was no difference in six-month treatment success between the two groups (72% vs. 70%) but with lower costs. [5] There is also little known about the effectiveness of PPIs and H 2 RAs in patients with dyspepsia presented to the emergency department (ED).…”

Section: Introductionmentioning

confidence: 99%

Comparison of intravenous pantoprazole and ranitidine in patients with dyspepsia presented to the emergency department: a randomized, double blind, controlled trial

Senay

Eken

YILDIZ>

et al. 2016

World Journal of Emergency Medicine

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BACKGROUND:This study aimed to compare pantoprazole, a proton-pomp inhibitors (PPIs), and ranitidine, a H 2 receptor antagonists (H 2 RA), in ceasing dyspeptic symptoms in the emergency department (ED). METHODS:This randomized, double-blinded study compared the effectiveness of 50 mg ranitidine (Ulcuran ® ) and 40 mg pantoprazole (Pantpas ® ), given in a 100 mL saline solution by an intravenous rapid infusion within 2-4 minutes in patients with dyspepsia presented to the ED. Pain intensity was measured at baseline, 30 and 60 minutes after the drug administration.RESULTS: A total of 72 patients were eligible for the study. Of these patients, 2 were excluded from the study because the initial visual analogue scale (VAS) scores were under 20 mm and 4 were excluded from the statistical analysis because of being diagnosed as having other causes of epigastric pain despite being allocated to one of the study groups. Thirty-three patients in the pantoprazole group and 33 patients in the ranitidine group were analyzed ultimately. The mean age of the patients was 36.6±15 years, and 26 (39.4%) patients were male. Both of the groups reduced pain effectively at 30 [27.6±28 (18 to 37) vs. 28.3±23 (20 to 37), respectively] and 60 minutes [39.6±39 (26 to 53) vs. 42.3±25 (33 to 51), respectively]. There were 13 (39.4%) patients in the pantoprazole group and 8 (24.2%) patients in the ranitidine group who required additional drug at the end of the study (P=0.186).CONCLUSION: Intravenous pantoprazole and ranitidine are not superior to each other in ceasing dyspeptic symptoms at 30 and 60 minutes in the ED.

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Initial management strategies for dyspepsia

Cited by 99 publications

References 62 publications

3rd BRAZILIAN CONSENSUS ON Helicobacter pylori

3rd BRAZILIAN CONSENSUS ON Helicobacter pylori

Variation in the use of H. pylori tests in UK general practice – a qualitative study

Comparison of intravenous pantoprazole and ranitidine in patients with dyspepsia presented to the emergency department: a randomized, double blind, controlled trial

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