Arents Nicolaas L A, Thijs Jacob C, van Zwet Anton A, Oudkerk Pool Marco, Gotz Jan-Mark, van de Werf Ger T, Reenders Klaas, Sluiter Wim J, Kleibeuker Jan H
Regional Public Health Laboratory, Groningen/Drenthe, The Netherlands.
Arch Intern Med. 2003 Jul 14;163(13):1606-12. doi: 10.1001/archinte.163.13.1606.
The value of the "test-and-treat" strategy in the approach to dyspepsia has been evaluated only in a few secondary care studies. Most patients with dyspepsia, however, are treated by their primary care physician. This study evaluated the test-and-treat strategy in primary care.
Patients consulting their general practitioners for dyspepsia were randomized to either direct open-access endoscopy with Helicobacter pylori testing or a test-and-treat strategy by H pylori serology. In the 12-month follow-up period, any additional treatment or referral for investigations was left at the discretion of the general practitioner. At the end of the study, data were collected concerning the number of endoscopies, changes in symptom severity and quality of life, patient satisfaction, and the use of medical resources.
Two hundred seventy patients were enrolled (129 who received endoscopy and 141 in the test-and-treat group). The prevalence of H pylori infection was 38.3% and 37.2% in the test-and-treat and endoscopy groups, respectively. In the test-and-treat group, 46 patients (33%) were referred for endoscopy during follow-up. Improvement in symptom severity, quality of life, and patient satisfaction was comparable in both groups. Patients in the test-and-treat group paid more dyspepsia-related visits to their general practitioner (P =.005). Patients in the endoscopy group were more often prescribed proton pump inhibitors (P =.007), whereas patients in the test-and-treat group were more often prescribed prokinetic drugs (P =.005).
The test-and-treat strategy proved to be as effective and safe as prompt endoscopy. Only a minority of patients were referred for endoscopy after the test-and-treat approach.
“检测并治疗”策略在消化不良治疗中的价值仅在少数二级医疗研究中得到评估。然而，大多数消化不良患者由其初级保健医生治疗。本研究评估了初级保健中的“检测并治疗”策略。
因消化不良向全科医生咨询的患者被随机分为直接开放式胃镜检查并检测幽门螺杆菌组或通过幽门螺杆菌血清学进行“检测并治疗”策略组。在12个月的随访期内，任何额外的治疗或检查转诊由全科医生自行决定。在研究结束时，收集了关于胃镜检查次数、症状严重程度和生活质量的变化、患者满意度以及医疗资源使用的数据。
共纳入270例患者（129例接受胃镜检查，141例在“检测并治疗”组）。“检测并治疗”组和胃镜检查组的幽门螺杆菌感染率分别为38.3%和37.2%。在“检测并治疗”组中，46例患者（33%）在随访期间被转诊进行胃镜检查。两组在症状严重程度、生活质量和患者满意度方面的改善相当。“检测并治疗”组的患者因消化不良去看全科医生的次数更多（P = 0.005）。胃镜检查组的患者更常被开质子泵抑制剂（P = 0.007），而“检测并治疗”组的患者更常被开促动力药物（P = 0.005）。
“检测并治疗”策略被证明与立即进行胃镜检查一样有效和安全。在“检测并治疗”方法后，只有少数患者被转诊进行胃镜检查。
