Ford A C, Moayyedi P, Jarbol D E, Logan R F A, Delaney B C
Division of Gastroenterology, McMaster University, Health Sciences Centre, Hamilton, ON, Canada.
Aliment Pharmacol Ther. 2008 Sep 1;28(5):534-44. doi: 10.1111/j.1365-2036.2008.03784.x. Epub 2008 Jun 27.
Which of Helicobacter pylori'test and treat' or empirical acid suppression should be preferred for the initial management of uncomplicated dyspepsia is controversial. Aim To conduct an individual patient data meta-analysis of randomized controlled trials (RCTs) of 'test and treat' vs. empirical acid suppression in adults with uncomplicated dyspepsia in primary care.
Investigators provided original data sets for analysis. Effect of management strategy on symptom status and dyspepsia-related resource use at 12-month follow-up was examined by pooling symptom and cost data to obtain relative risk (RR) of remaining symptomatic at 12 months and weighted mean difference (WMD) in costs between the two strategies with 95% confidence intervals (CI).
We identified three eligible RCTs containing 1547 patients, 791 (51%) of whom were assigned to 'test and treat'. There was no difference detected in symptom-cure at 12 months (RR = 0.99; 95% CI: 0.95-1.03). There was a nonsignificant trend towards cost-savings with 'test and treat' (WMD in costs = - 28.91 pound; 95% CI: - 68.48 pound to 10.65 pound).
There was little difference in symptom-resolution or costs between the two strategies. A combination of patient and physician preference should determine the initial approach to the management of uncomplicated dyspepsia.
在初级保健中，对于单纯性消化不良的初始管理，幽门螺杆菌“检测和治疗”与经验性抑酸治疗哪种方法更可取存在争议。目的：对初级保健中成人单纯性消化不良的“检测和治疗”与经验性抑酸治疗的随机对照试验（RCT）进行个体患者数据荟萃分析。
研究人员提供原始数据集进行分析。通过汇总症状和成本数据，以获得12个月时仍有症状的相对风险（RR）以及两种策略之间成本的加权平均差（WMD）和95%置信区间（CI），来检验管理策略对12个月随访时症状状态和消化不良相关资源使用的影响。
我们确定了三项符合条件的RCT，共纳入1547例患者，其中791例（51%）被分配至“检测和治疗”组。12个月时症状治愈情况无差异（RR = 0.99；95%CI：0.95 - 1.03）。“检测和治疗”组有节省成本的非显著趋势（成本WMD = - 28.91英镑；95%CI：- 68.48英镑至10.65英镑）。
两种策略在症状缓解或成本方面差异不大。患者和医生的偏好应共同决定单纯性消化不良初始管理的方法。
