Bytzer Peter
Department of Medical Gastroenterology and Endoscopy, Glostrup University Hospital, DK-2600 Glostrup, Denmark.
Best Pract Res Clin Gastroenterol. 2004 Aug;18(4):681-93. doi: 10.1016/j.bpg.2004.04.005.
The optimal diagnostic approach to the dyspeptic patient in primary care is still debated. Early endoscopy continues to be the diagnostic gold standard but competing non-invasive strategies challenge this. The most important approaches are empiric antisecretory treatment reserving endoscopy for unresponsive patients and patients with an early symptomatic relapse and helicobacter-based strategies reserving endoscopy for infected patients (test-and-scope) or for failures after eradication therapy (test-and-treat). Early endoscopy is recommended in patients with alarm features and should be considered in patients with new onset dyspepsia after age 50. In the remaining patients, early investigation can only be recommended in areas providing endoscopy at a low cost and with a short waiting list. The test-and-scope strategy may lead to a rise in the referral rates for endoscopy and cannot be recommended. The test-and-treat strategy is well documented in clinical trials as a safe and cost-effective approach. Helicobacter-based strategies are challenged by a decreasing prevalence of peptic ulcer disease and of the infection. In the near future, the empirical acid inhibition strategy will probably be cost-effective as gastro-oesophageal reflux becomes the predominant disorder in dyspeptic patients.
基层医疗中消化不良患者的最佳诊断方法仍存在争议。早期内镜检查仍是诊断的金标准，但其他非侵入性诊断策略对其构成了挑战。最重要的方法包括：经验性抗分泌治疗，仅对无反应患者和早期症状复发患者进行内镜检查；基于幽门螺杆菌的策略，仅对感染患者（检测并内镜检查）或根除治疗失败的患者（检测并治疗）进行内镜检查。有警示特征的患者建议早期进行内镜检查，50岁后新发消化不良的患者应考虑进行内镜检查。对于其余患者，只有在能以低成本提供内镜检查且等待名单较短的地区，才建议早期进行检查。检测并内镜检查策略可能会导致内镜检查转诊率上升，因此不建议采用。检测并治疗策略在临床试验中有充分记录，是一种安全且具有成本效益的方法。基于幽门螺杆菌的策略受到消化性溃疡疾病及其感染患病率下降的挑战。在不久的将来，随着胃食管反流成为消化不良患者的主要疾病，经验性抑酸策略可能会具有成本效益。
