Comparison between empirical prokinetics, Helicobacter testand-treat and empirical endoscopy in primary-care patients presenting with dyspepsia: A one-year study

R5; AIM: To investigate the optimal strategy to treat dyspeptic patients in primary care.METHODS: Dyspeptic patients presenting to primary care outpatient clinics were randomly assigned to:(1) empirical endoscopy, (2)Hpylori test-and-treat,and (3) empirical prokinetic treatment with cisapride.Early endoscopy was arranged if patients remained symptomatic after 2 wk. Symptom severity, quality-oflife (SF-36) as well as patient preference and satisfaction were assessed. All patients underwent endoscopy by wk 6. Patients were followed up for one year.RESULTS: Two hundred and thirty four patients were recruited (163 female, mean age 49). 46% were H pylori positive. 26% of H pylori tested and 25% of empirical prokinetic patients showed no improvement at wk 2follow-up and needed early endoscopy. 15% of patients receiving empirical cisapride responded well to treatment but peptic ulcer was the final diagnosis. Symptom resolution and quality-of-life were similar among the groups. Costs for the three strategies were HK$4343,$1771 and $1750 per patient. 66% of the patients preferred to have early endoscopy.CONCLUSION: The three strategies are equally effective. Empirical prokinetic treatment was the least expensive but peptic ulcers may be missed with this treatment. The H pylori test-and-treat was the most cost-effective option.