Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
Clin Transl Gastroenterol. 2013 Mar 28;4(3):e32. doi: 10.1038/ctg.2013.3.
Deciding on whether the Helicobacter pylori test-and-treat strategy is an appropriate diagnostic-therapeutic approach for patients with dyspepsia invites a series of questions. The aim present article addresses the test-and-treat strategy and attempts to provide practical conclusions for the clinician who diagnoses and treats patients with dyspepsia.
Bibliographical searches were performed in MEDLINE using the keywords Helicobacter pylori, test-and-treat, and dyspepsia. We focused mainly on data from randomized controlled trials (RCTs), systematic reviews, meta-analyses, cost-effectiveness analyses, and decision analyses.
Several prospective studies and decision analyses support the use of the test-and-treat strategy, although we must be cautious when extrapolating the results from one geographical area to another. Many factors determine whether this strategy is appropriate in each particular area. The test-and-treat strategy will cure most cases of underlying peptic ulcer disease, prevent most potential cases of gastroduodenal disease, and yield symptomatic benefit in a minority of patients with functional dyspepsia. Future studies should be able to stratify dyspeptic patients according to their likelihood of improving after treatment of infection by H. pylori.
The test-and-treat strategy will cure most cases of underlying peptic ulcer disease and prevent most potential cases of gastroduodenal disease. In addition, a minority of infected patients with functional dyspepsia will gain symptomatic benefit. Several prospective studies and decision analyses support the use of the test-and-treat strategy. The test-and-treat strategy is being reinforced by the accumulating data that support the increasingly accepted idea that "the only good H. pylori is a dead H. pylori".
决定是否采用幽门螺杆菌检测-治疗策略作为消化不良患者的诊断-治疗方法，需要考虑一系列问题。本文旨在探讨检测-治疗策略，并尝试为诊断和治疗消化不良患者的临床医生提供实用结论。
在 MEDLINE 中使用关键词“Helicobacter pylori（幽门螺杆菌）”、“test-and-treat（检测-治疗）”和“dyspepsia（消化不良）”进行文献检索。我们主要关注随机对照试验（RCT）、系统评价、荟萃分析、成本效益分析和决策分析的数据。
多项前瞻性研究和决策分析支持采用检测-治疗策略，但我们在将一个地区的结果外推到另一个地区时必须谨慎。许多因素决定了该策略在特定地区是否适用。检测-治疗策略将治愈大多数潜在的消化性溃疡疾病，预防大多数潜在的胃十二指肠疾病，并使少数功能性消化不良患者获得症状改善。未来的研究应该能够根据患者治疗幽门螺杆菌感染后改善的可能性对消化不良患者进行分层。
检测-治疗策略将治愈大多数潜在的消化性溃疡疾病并预防大多数潜在的胃十二指肠疾病。此外，少数感染了幽门螺杆菌的功能性消化不良患者将获得症状改善。多项前瞻性研究和决策分析支持采用检测-治疗策略。检测-治疗策略得到了越来越多支持“唯一有益的幽门螺杆菌是死亡的幽门螺杆菌”这一观点的累积数据的支持。
