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

作　　者：Wayne HC Hu SK Lam Cindy LK Lam WM Wong KF Lam KC Lai YH Wong Benjamin CY Wong Annie OO Chan CK Chan Gabriel M Leung WM Hui 

机构地区：[1]Department of Medicine, University of Hong Kong, Hong Kong, China [2]Department of Statistics and Actuarial Science, University of Hong Kong, Hong Kong, China [3]Department of Community Medicine, University of Hong Kong, Hong Kong, China

出　　处：《World Journal of Gastroenterology》2006年第31期5010-5016,共7页世界胃肠病学杂志（英文版）

基　　金：Supported by the peptic ulcer research fund and the Simon To fund for swallowing and functional gastrointestinal disorders

摘　　要：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） H pylori test-and-treat, and （3） empirical prokinetic treatment with cisapride. Early endoscopy was arranged if patients remained symptomatic after 2 wk. Symptom severity, quality-of-life （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 2 follow-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 .瞄准：调查最佳的策略在主要照顾对待消化不良的病人。方法：介绍给主要照顾门诊病人诊所的消化不良的病人随机被分到：(1 ) 实验内视镜检查法，(2 ) H pylori test-and-treat，并且(3 ) 实验专业版有 cisapride 的运动治疗。如果病人们在 2 wk 以后仍然保持征兆，早内视镜检查法被安排。症状严厉， quality-of-life (SF-36 ) 以及耐心的偏爱和满足被估计。所有病人由 wk 经历了内视镜检查法 6。病人们被跟随在上面为一年。结果：二百和三十四个病人被招募(163 女、吝啬的年龄 49 ) 。46% 是 H pylori 积极。测试的 26% H pylori 和运动病人显示出的 25% 实验专业版在 wk 的没有改进 2 后续和需要的早内视镜检查法。收到实验 cisapride 的 15% 病人对治疗作出回应很好，但是消化性溃疡是最后的诊断。症状分辨率和 quality-of-life 在这些组之中是类似的。为三策略的费用是每病人的 HK 美元 4343，美元 1771 和美元 1750。66% 病人喜欢有早内视镜检查法。结论：三策略是同等地有效的。实验专业版运动治疗是最不昂贵的，但是消化性溃疡可以与这治疗被错过。H pylori test-and-treat 是最划算的选择。

关 键 词：Empirical endoscopy Dyspeptic patients Hpylori test-and treat 

分 类 号：R57[医药卫生—消化系统]