[Safety of Helicobacter pylori 'test-and-treat' strategies for the management of uninvestigated dyspepsia].

OBJECTIVE

To verify the safety of Helicobacter pylori (Hp) 'test-and-treat' and 'test-and-endoscopy' strategies for management of uninvestigated dyspepsia in Shanghai patients.

METHODS

14,101 consecutive patients presented with dyspepsia receiving endoscopy during Oct. 2002 to Dec. 2003 were retrospectively analyzed in this study. The detective rate of esophageal or gastroduodenal malignancies and alarm symptoms were investigated and Hp status was assessed.

RESULTS

Total 202 (1.43%) malignancies were found, including gastric cancer in 162 (1.15%), malignant gastric lymphoma in 4, esophageal cancer in 35 (0.25%) and duodenal cancer in 1. Among those patients with malignancies, ninety-nine (49.0%) patients were infected with Hp and 108 (53.5%) presented with alarm symptoms. Eighteen patients (0.46%) under the age of 45 years were diagnosed as gastric cancer. Among these patients, 5 (27.8%) presented with alarm symptoms and 13 (72.2%) were infected with Hp. If the Hp 'test-and-treat'strategy was used in dyspeptic patients under the age of 45 years without alarm symptoms in Shanghai region, then 13 cases (72.2%) of gastric cancer would be missed. If the Hp 'test-and-endoscopy' strategy was applied, then 3 cases (16.7%) of gastric cancer would be missed.

CONCLUSIONS

Hp 'test-and-treat' and 'test-and-endoscopy' strategies are all not suitable for the management of uninvestigated dyspepsia in Shanghai patients. For most Shanghai adult dyspeptic patients, prompt endoscopy should be recommended as the first-line initial management option.