Testing for Helicobacter pylori, and acid-suppression therapy are nearly always better strategies
Most patients with upper gastrointestinal symptoms can be effectively managed without investigation. Recent long-term follow-up of patients with upper gastrointestinal symptoms shows that most have a benign course.1,2 A recent follow-up of 300 patients 9 years after investigations showed that 40% were asymptomatic; 70% of these without medication.2 Such a good outcome is the result of the decline of Helicobacter pylori3 (making peptic ulcer uncommon and gastric cancer rare in the absence of genetic or ethnic predisposition) and the easy availability of effective acid-suppression therapy (making gastro-oesophageal reflux disease easily treatable). For the vast majority of patients, upper gastrointestinal symptoms are now a dis-ease, not a disease.
The full article is accessible to AMA members and paid subscribers. Login to read more or purchase a subscription now.
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
- John Hunter Hospital, Newcastle, NSW.
- 1. Agreus L. Natural history of dyspepsia. Gut 2002; 50 Suppl 4: iv2-iv9.
- 2. Westbrook JI, Duggan AE, Duggan JM, Westbrook MT. A 9 year prospective cohort study of endoscoped patients with upper gastrointestinal symptoms. Eur J Epidemiol 2005; 20: 619-627.
- 3. Calam J. Clinician’s guide to Helicobacter pylori. London: Chapman and Hall Medical, 1996.
- 4. Talley N. American Gastroenterological Association medical position statement: evaluation of dyspepsia. Gastroenterology 2005; 129: 1753-1755.
- 5. Tytgat GN. Role of endoscopy and biopsy in the work up of dyspepsia. Gut 2002; 50 Suppl 4: iv13-iv16.
- 6. Numans ME, Lau J, de Wit NJ, Bonis PA. Short-term treatment with proton-pump inhibitors as a diagnostic test for gastroesophageal reflux disease: a meta-analysis of diagnostic test characteristics. Ann Intern Med 2004; 140: 518-527.
- 7. Westbrook JI, McIntosh J, Talley NJ. Factors associated with consulting medical or non-medical practitioners for dyspepsia: an Australian population-based study. Aliment Pharmacol Ther 2000; 14: 1581-1588.
- 8. Engel LS, Chow W-H, Vaughan TL, et al. Population attributable risks of esophageal and gastric cancers. J Natl Cancer Inst 2003; 95: 1404-1413.
- 9. Forman D. Review article: oesophago-gastric adenocarcinoma — an epidemiological perspective. Aliment Pharmacol Ther 2004; 20 Suppl 5: 55-60.
- 10. Schmidt N, Peitz U, Lippert H, Malfertheiner P. Missing gastric cancer in dyspepsia. Aliment Pharmacol Ther 2005; 21: 813-820.
- 11. Ford AC, Qume M, Moayyedi P, et al. Helicobacter pylori “test and treat” or endoscopy for managing dyspepsia: an individual patient data meta-analysis. Gastroenterology 2005; 128: 1838-1844.
- 12. Australian Institute of Health and Welfare. Interactive cancer data. Number of new cases and age-specific rates for selected cancers by year of registration, sex and 5-year age groups. http://www.aihw.gov.au/cognos/cgi-bin/ppdscgi.exe?DC=Q&E=/Cancer/cancerageratesv7 (accessed Dec 2006).
- 13. Vakil N, Moayyedi P, Fennerty MB, Talley NJ. Limited value of alarm features in the diagnosis of upper gastrointestinal malignancy: systematic review and meta-analysis. Gastroenterology 2006; 131: 390-401.