VIEWS & REVIEWS Recommendations on general practice management of dyspepsia Some recommendations for the management of newly diagnosed dyspepsia in general practice have been compiled by Dr Lars Agreus from Uppsala University, Sweden, and Dr Nicholas Talley from the University of Sydney, Australia. The main points of their recommendations are listed below. • The empirical treatment of dyspepsia should not be guided by subgrouping of symptoms (e.g. reflux-like vs ulcer-like dyspepsia). • Prompt endoscopy should be carried out where there are symptoms of underlying disease and where NSAIDs have been used • Helicobacter pylori is more accurately diagnosed by urea breath test than by blood test. Though more expensive than a blood test, prompt use of the urea breath test may be more economical as fewer endoscopies are needed to confirm the diagnosis. • The use of acid-reducing or prokinetic agents for all patients with newly diagnosed dyspepsia is inappropriate because those with peptic ulcer disease will be treated inadequately. • If prompt endoscopy is not possible, eradication of H. pylori in patients with dyspepsia who are positive for the organism is preferable to other empirical treatment, as most patients with peptic ulcer can be cured, and only those with other symptoms or treatment failure will then require endoscopy. • A trial of an acid-reducing or prokinetic drug is 'reasonable' in patients who are H. pylori-negative and who are not satisfied with reassurance alone. AgrWs 1., Talley N. <l1allenges in managing dyspepsia in gclX'l2i practice. British Medical Joumal315: 1284-1288. 15 Nov 1997 Il00628,99 1173-8324197N114-OOO31$Ol . cxf Adlalm.rn.tionlll LImIt8d111117. All rlghta 3 Inpllarma- 22 Nov 1l1li7 No. 1114

Recommendations on general practice management of dyspepsia

Download PDF Report

View
217
Download
5

Embed Size (px)

Citation preview

VIEWS & REVIEWS

Recommendations on general practice management of dyspepsia

Some recommendations for the management of newly diagnosed dyspepsia in general practice have been compiled by Dr Lars Agreus from Uppsala University, Sweden, and Dr Nicholas Talley from the University of Sydney, Australia.

The main points of their recommendations are listed below. • The empirical treatment of dyspepsia should not be

guided by subgrouping of symptoms (e.g. reflux-like vs ulcer-like dyspepsia).

• Prompt endoscopy should be carried out where there are symptoms of underlying disease and where NSAIDs have been used

• Helicobacter pylori is more accurately diagnosed by urea breath test than by blood test. Though more expensive than a blood test, prompt use of the urea breath test may be more economical as fewer endoscopies are needed to confirm the diagnosis.

• The use of acid-reducing or prokinetic agents for all patients with newly diagnosed dyspepsia is inappropriate because those with peptic ulcer disease will be treated inadequately.

• If prompt endoscopy is not possible, eradication of H. pylori in patients with dyspepsia who are positive for the organism is preferable to other empirical treatment, as most patients with peptic ulcer can be cured, and only those with other symptoms or treatment failure will then require endoscopy.

• A trial of an acid-reducing or prokinetic drug is 'reasonable' in patients who are H. pylori-negative and who are not satisfied with reassurance alone.

AgrWs 1., Talley N. <l1allenges in managing dyspepsia in gclX'l2i practice. British Medical Joumal315: 1284-1288. 15 Nov 1997 Il00628,99

1173-8324197N114-OOO31$Ol .cxf Adlalm.rn.tionlll LImIt8d111117. All rlghta ~

Inpllarma- 22 Nov 1l1li7 No. 1114