Management in general practice of patients with persistent dyspepsia. A decision analysis.

To determine whether an empirical drug treatment strategy (empirical group) instead of upper gastrointestinal endoscopy followed by treatment (conventional group) in patients with persistent dyspepsia increases appropriate use of endoscopy facilities, we did a decision analysis based on data found in the literature. We estimated the percentage of patients having an upper gastrointestinal endoscopy in 1 year, the percentage of patients with symptom relief, and the average medical costs per patient for both groups. In the empirical group, fewer patients (38%) had upper gastrointestinal endoscopies compared with the conventional group. Furthermore, an additional 5% of patients in the empirical group experienced symptom relief, and the average medical costs per patient were estimated to be 8% less in this group when compared with the patients in the conventional treatment group. The proposed empirical drug treatment strategy for patients with persistent dyspepsia results in the performance of fewer diagnostic upper gastrointestinal endoscopies per year with greater effectiveness compared with upper gastrointestinal endoscopy followed by treatment.