Moayyedi P, Zilles A, Clough M, Hemingbrough E, Chalmers D M, Axon A T
Centre for Digestive Diseases, The General Infirmary at Leeds, UK.
Eur J Gastroenterol Hepatol. 1999 Nov;11(11):1245-50. doi: 10.1097/00042737-199911000-00010.
(1) To investigate the effects of a Helicobacter pylori screening and treatment strategy on open access endoscopy referral rates in dyspeptic patients aged < 40 years. (2) To determine the effectiveness of an H. pylori screening and treatment strategy, compared with endoscopy, in reducing dyspeptic symptoms, and in the utilization of dyspepsia related health care in general practice.
Subjects were dyspeptic patients aged < 40 years, who were not taking NSAIDs and were without sinister symptoms. Patients were referred by their general practitioners.
The proportion of endoscopies carried out in patients aged < 40 years during the 5 years before the introduction of a screening and treatment strategy was compared with the proportion 2 years afterwards, as determined in a retrospective audit. Dyspepsia scores were obtained from unselected endoscopy patients and those who received a 13C-urea breath test (13C-UBT) at their initial visit and 6 months later. The number of visits made by patients with dyspepsia to their GPs, as well as the number of prescriptions given for antisecretory drugs, during the 6 months before attending for investigation were compared, in the same patient groups, with the same variables during the 6 months after the investigation.
There was a 37% reduction in open access endoscopies performed in patients aged < 40 years (95% CI, 34-40%) following the introduction of the 13C-UBT service. Six months after attending the 13C-UBT service there was a significant fall in dyspepsia score (15.5 +/- 7.4 to 7.2 +/- 7.0, P < 0.0001), general practice dyspepsia consultations (2.0 +/- 1.3 to 1.0 +/- 1.7, P < 0.0001), H2 receptor antagonist prescription (14.2 +/- 32.6 tablets to 6.7 +/- 25.6 tablets, P = 0.006) but not proton pump inhibitor prescription (6.9 +/- 21.9 tablets to 7.2 +/- 27.6 tablets, P = 0.90). These changes were not significantly different from those found in the open access endoscopy control patients.
An H. pylori screening and treatment strategy reduces the endoscopy workload in young dyspeptic patients. This strategy appears to be as effective as endoscopy in reducing dyspepsia symptoms, dyspepsia consultation rates and the prescribing of anti-secretory drugs.
(1)研究幽门螺杆菌筛查和治疗策略对40岁以下消化不良患者开放获取式内镜检查转诊率的影响。(2)确定幽门螺杆菌筛查和治疗策略与内镜检查相比,在减轻消化不良症状以及在全科医疗中使用与消化不良相关的医疗服务方面的有效性。
研究对象为40岁以下的消化不良患者,这些患者未服用非甾体抗炎药且无严重症状。患者由其全科医生转诊而来。
通过回顾性审计,比较在引入筛查和治疗策略前5年以及之后2年中40岁以下患者进行内镜检查的比例。从未经选择的内镜检查患者以及初次就诊时和6个月后接受13C-尿素呼气试验(13C-UBT)的患者中获取消化不良评分。比较同一患者组中消化不良患者在接受检查前6个月内去看全科医生的次数以及抗分泌药物的处方数量,与检查后6个月内的相同变量进行比较。
引入13C-UBT服务后,40岁以下患者进行的开放获取式内镜检查减少了37%(95%置信区间,34 - 40%)。接受13C-UBT服务6个月后,消化不良评分显著下降(从15.5±7.4降至7.2±7.0,P < 0.0001),全科医疗中消化不良会诊次数减少(从2.0±1.3降至1.0±1.7,P < 0.0001),H2受体拮抗剂处方量减少(从14.2±32.6片降至6.7±25.6片,P = 0.006),但质子泵抑制剂处方量无变化(从6.9±21.9片降至7.2±27.6片,P = 0.90)。这些变化与开放获取式内镜检查对照患者中发现的变化无显著差异。
幽门螺杆菌筛查和治疗策略可减轻年轻消化不良患者的内镜检查工作量。该策略在减轻消化不良症状、消化不良会诊率以及抗分泌药物处方方面似乎与内镜检查同样有效。