Helicobacter pylori test and eradicate versus prompt endoscopy for management of dyspeptic patients:: 6.7 year follow up of a randomised trial

Background: Dyspepsia is a chronic disease with significant impact on the use of health care resources. A management strategy based on Helicobacter pylori testing has been recommended but the long term effect is unknown. Aim: To investigate the long term effect of a test and treat strategy compared with prompt endoscopy for management of dyspeptic patients in primary care. Patients: A total of 500 patients presenting in primary care with dyspepsia were randomised to management by H pylori testing plus eradication therapy (n = 250) or by endoscopy ( n = 250). Results of 12 month follow up have previously been presented. Methods: Symptoms, quality of life, and patient satisfaction were recorded during a three month period, a median 6.7 years after randomisation ( range 6.1 - 7.3 years). Number of endoscopies, antisecretory medication, H pylori treatments, and hospital visits were recorded from health care databases for the entire follow up period. Results: Median age was 45 years; 28% were H pylori infected. Use of resources was registered in all 500 patients ( 3084 person years) of whom 312 completed diaries. We found no difference in symptoms between the two groups. Median proportion of days without symptoms was 0.52 ( interquartile range 0.10 - 0.88) in the test and eradicate group versus 0.64 (0.14 - 0.90) in the prompt endoscopy group ( p = 0.27) ( mean difference 0.05 (95% confidence interval (CI) -0.03 to 0.14)). Compared with the prompt endoscopy group, the test and eradicate group underwent fewer endoscopies ( mean difference 0.62 endoscopies/person ( 95% CI 0.38 - 0.86)) and used less antisecretory medication ( mean difference 102 defined daily doses/person ( 95% CI -1 to 205)). Conclusion: On a long term basis, a H pylori test and eradicate strategy is as efficient as prompt endoscopy for management of dyspeptic patients in primary care and reduces the use of endoscopy and antisecretory medication.