Rabeneck L, Wray N P, Graham D Y
Department of Veterans Affairs Medical Center, Houston, Texas 77030, USA.
Am J Gastroenterol. 1998 Jun;93(6):920-4. doi: 10.1111/j.1572-0241.1998.277_e.x.
The conceptual revolution concerning the role of Helicobacter pylori in the pathogenesis of peptic ulcer disease has raised the larger question of how to integrate this new information into the management of patients with dyspepsia. The aim of this research was to critically evaluate current knowledge about dyspepsia and its management.
Relevant articles on dyspepsia were identified from MEDLINE searches and from the bibliographies of identified articles. Studies that contained information on the prevalence of dyspepsia, endoscopic findings, and evaluations of alternative management strategies were reviewed.
By coupling H. pylori serological testing with clinical factors such as age and nonsteroidal antiinflammatory drug use, strategies have been developed that identify patients with organic disease. Although the use of these strategies can reduce the volume of endoscopies, their effects on dyspepsia symptoms are unknown. Computerized decision analysis models have been used to evaluate the cost-effectiveness of alternative strategies. The indirect evidence obtained from these models suggests that empiric therapy, guided by H. pylori testing, may be the preferred approach. However, the models have been hampered by the lack of information concerning dyspepsia symptoms, the primary health outcome of the majority of patients seen in primary practice settings.
Currently, the knowledge needed to integrate H. pylori tests and antimicrobial therapies into the management of patients with dyspepsia in primary practice settings has not been developed. A pressing need exists for a randomized controlled trial to evaluate alternative management strategies. In conducting such a trial, valid, reliable instruments for measuring dyspepsia will be needed.
关于幽门螺杆菌在消化性溃疡疾病发病机制中作用的概念性变革引发了一个更大的问题，即如何将这一新信息纳入消化不良患者的管理中。本研究的目的是批判性地评估当前关于消化不良及其管理的知识。
从MEDLINE检索以及已识别文章的参考文献中确定有关消化不良的相关文章。对包含消化不良患病率、内镜检查结果以及替代管理策略评估信息的研究进行了综述。
通过将幽门螺杆菌血清学检测与年龄和非甾体抗炎药使用等临床因素相结合，已制定出识别患有器质性疾病患者的策略。尽管使用这些策略可以减少内镜检查的数量，但其对消化不良症状的影响尚不清楚。计算机化决策分析模型已被用于评估替代策略的成本效益。从这些模型中获得的间接证据表明，以幽门螺杆菌检测为指导的经验性治疗可能是首选方法。然而，这些模型因缺乏有关消化不良症状的信息而受到阻碍，消化不良症状是在基层医疗环境中就诊的大多数患者的主要健康结局。
目前，尚未形成将幽门螺杆菌检测和抗菌治疗纳入基层医疗环境中消化不良患者管理所需的知识。迫切需要进行一项随机对照试验来评估替代管理策略。在进行这样的试验时，将需要有效、可靠的测量消化不良的工具。
