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Titolo:
A randomised controlled trial of four management strategies for dyspepsia:relationships between symptom subgroups and strategy outcome
Autore:
Lewin-van den Broek, NT; Numans, ME; Buskens, E; Verheij, TJM; de Wit, NJ; Smout, AJPM;
Indirizzi:
Univ Med Ctr, Julius Ctr Gen Practice & Patient Oriented Res, NL-3508 AB Utrecht, Netherlands Univ Med Ctr Utrecht Netherlands NL-3508 AB 3508 AB Utrecht, Netherlands
Titolo Testata:
BRITISH JOURNAL OF GENERAL PRACTICE
fascicolo: 469, volume: 51, anno: 2001,
pagine: 619 - 624
SICI:
0960-1643(200108)51:469<619:ARCTOF>2.0.ZU;2-P
Fonte:
ISI
Lingua:
ENG
Soggetto:
PREDICTING ENDOSCOPIC DIAGNOSIS; GASTROESOPHAGEAL REFLUX DISEASE; HELICOBACTER-PYLORI INFECTION; FUNCTIONAL DYSPEPSIA; PRIMARY-CARE; ERADICATION; PATIENT; ULCER;
Keywords:
randomised controlled trial; dyspepsia; therapy; disease management;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
25
Recensione:
Indirizzi per estratti:
Indirizzo: Numans, ME Univ Med Ctr, Julius Ctr Gen Practice & Patient Oriented Res, Stratenum 6-107,POB 85060, NL-3508 AB Utrecht, Netherlands Univ Med Ctr Stratenum 6-107,POB 85060 Utrecht Netherlands NL-3508 AB
Citazione:
N.T. Lewin-van den Broek et al., "A randomised controlled trial of four management strategies for dyspepsia:relationships between symptom subgroups and strategy outcome", BR J GEN PR, 51(469), 2001, pp. 619-624

Abstract

Background: The first step in the management of uncomplicated dyspepsia inprimary care often consists of prescribing empirical therapy, bite in certain cases prompt endoscopy might be preferred. Any decision is usually based on the patient's symptoms and the presumed underlying pathology that causes these symptoms. Aim: To assess the relationship between symptom subgroups and the effect of management strategies on primary care patients with dyspepsia. Design of study: Randomised controlled trial. Setting. All patients presenting successively with a new episode of dyspepsia between January 1995 and November 1997. Method. The results of four management strategies in dyspeptic primary care patients were compared and the value of subgrouping within this trial wasestimated. Patients were allocated to one of either (a) empirical treatment in which therapy was based on the presented symptoms, or empirical treatment with (b) omeprazole or (c) cisapride regardless of the presented symptoms, or (d) prompt endoscopy followed by the appropriate treatment. Patientswere retrospectively classified into the subgroups for each strategy usingbaseline data. The yield of each strategy was measured by counting the number of strategy failures in the first year. Results: Of the 349 included patients, 326 were analysed No statistically significant difference could be demonstrated between the strategies or between the symptom subgroups. However, patients in the reflux-like subgroup showed a trend towards a better outcome in all empirical strategies. Ulcer-like dyspepsia seemed to benefit from omeprazole. The non-specific subgroup seemed to benefit from cisapride but also had the highest proportion of strategy failure. Prompt endoscopy did not appear especially useful in any subgroup. Conclusion: Although this study has relatively low power we conclude that the use of symptom subgroups seems to he a sensible approach when choosing empirical therapy in dyspepsia. Patients with reflux-like symptoms seem to have the best prognosis in the first year in every strategy.

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Documento generato il 07/07/20 alle ore 04:44:48