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Abstract
Background Helicobacter pylori may have major implications for patients' wellbeing and future health. If a patient is found to be H. pylori positive it is important that the infection is eradicated because of the risk of associated peptic ulcers and gastric cancers. There are, however, great demands on NHS gastroenterology and endoscopy services and following the introduction of recent guidelines for dyspepsia some of these issues may be addressed. The literature suggests that a strategy of test and treat before endoscopy referral will benefit patients and be cost-effective.
Conclusion There is evidence that, over a period of time, it is more prudent to test and treat H. pylori first and then review the patient's condition before endoscopy is performed (if no other symptoms are identified).
Key words
* Endoscopy
* Gastrointestinal system and disorders
* Microbiology
* Peptic ulcers
These key words are based on the subject headings from the British Nursing Index. This article has been subject to double-blind review.
EVIDENCE suggests that Helicobacter pylori, a species of Gram-negative bacteria, has major implications not only for patients' wellbeing and future health but also for gastroenterology and endoscopy services. If a patient is H. pylori positive then it is necessary to eradicate the infection because of the risk of associated peptic ulcers and gastric cancer. The 'test and treat' strategy involves testing patients for H. pylori using a breath test or serology followed by H. pylori eradication in those with H. pylori (Box 1) and symptomatic therapy for the remainder. A number of management trials have demonstrated that the test and treat strategy is as effective as endoscopy in determining therapy for dyspepsia (British Society of Gastroenterology (BSG) 2002).
H. pylori is associated with symptoms that come under the general heading of dyspepsia. Koch and Lancaster Smith (2003) describe two types of dyspepsia: 'ulcer-like' and 'dysmotility-like' dyspepsia. Ulcer-like symptoms include a burning epigastric pain or discomfort that often occurs at night and improves after eating, while dysmotility-like dyspepsia relates to a sensation of fullness, nausea, bloating and vomiting. Dyspepsia is extremely common in western society with a prevalence of 25-40 per cent over a six to 12 month period - 25 per cent of patients consult a doctor and 2 per cent of...