Is therapy based on endoscopy results better than empiric therapy for dyspepsia?

Abstract

In the initial management of dyspepsia for patients without "alarm" symptoms (weight loss, recurrent vomiting, dysphagia, anemia, evidence of bleeding, onset of dyspepsia after age 45 years), therapy based on the results of early endoscopy was not better than empiric acid suppression (antisecretory therapy) or a Helicobacter pylori "test and treat" strategy in reducing symptoms or improving quality of life (strength of recommendation [SOR]: A, based on a systematic review). Results from studies of patient satisfaction comparing early endoscopy with empiric medication therapy are conflicting (SOR: A, based on 2 randomized controlled trials [RCTs]). Though formal cost analyses are not available, a strategy using "test and treat" as opposed to early endoscopy, results in significantly fewer endoscopies, which when formally evaluated, may translate into a more cost-effective strategy of care (SOR: A, based on a systematic review). Long-term followup suggests that patients receiving "test and treat" therapy may require fewer antisecretory medication prescriptions compared with patients receiving early endoscopy (SOR: B, based on a single RCT).