Test ed eradicazione versus trattamento "dettato" dall'endoscopia nella dispepsia Helicobacter pylori-positiva

Test-and-treat approach to young H. pylori-positive dyspeptics without sinister symptoms is currently promoted in many European countries for its cost-effectiveness. This study was undertaken to determine whether empiric eradication of H. pylori relieve symptoms in primary care dyspeptic patients. 200 patients (aged under 45) presenting to their GP for dyspepsia (> 3-week duration) were tested for H. pylori using 13C-Urea breah test (UBT). H. pylori-positive pts were randomised to either empirical eradication or prompt endoscopy, similarly, H. pylori-negative pts were randomly allocated to empiric therapy or prompt endoscopy. Dyspeptic symptoms scores, patients' satisfaction and the use of additional resources were evaluated before and during a 1 year follow-up. Dyspepsia scores significantly improved in both H. pylori-positive groups over 12 months compared with baseline, with no significant differences between the two groups as for patients' satisfaction. By contrast symptoms score did not significantly reduce over time both in H. pylori-negative pts receiving endoscopy-dictated therapy and in those treated empirically. These preliminary findings suggest that also in our country H.pylori test-and-eradicate strategy is as effective as endoscopy-dictated therapy for the management of young dyspeptic in primary care.