Randomised controlled trial of Helicobacter pylori testing and endoscopy for dyspepsia in primary care

Area of Science:

• Gastroenterology
• Health Economics
• Primary Care Medicine

Background:

• Dyspepsia is a common condition managed in primary care.
• Helicobacter pylori (H pylori) infection is a potential cause of dyspepsia.
• Current management strategies vary, impacting resource utilization and patient outcomes.

Purpose of the Study:

• To evaluate the cost-effectiveness of a near-patient H pylori testing strategy followed by endoscopy for dyspepsia management.
• To compare this strategy against usual primary care practices.

Main Methods:

• A randomized controlled trial involving 478 patients under 50 years old with dyspepsia was conducted across 31 UK primary care centers.
• The intervention group received near-patient H pylori testing with open-access endoscopy for positive results.
• The control group received standard care, including acid-suppressing drugs or specialist referral at the general practitioner's discretion.

Main Results:

• The intervention group showed higher rates of H pylori testing (40%) and endoscopy (45% vs. 25% in controls).
• Peptic ulcer diagnoses were more frequent in the intervention group (7.4% vs. 2.1%).
• No significant differences were observed in symptom improvement, quality of life, prescribing, consultation, or referral rates between groups. The intervention group incurred higher costs (£367.85 vs. £253.16 per patient).

Conclusions:

• The near-patient H pylori testing and endoscopy strategy effectively increases endoscopy utilization in primary care.
• However, this strategy does not provide additional benefits in symptom relief or quality of life compared to usual care.
• The increased costs associated with the intervention strategy are not offset by demonstrable clinical or quality-of-life improvements.