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Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
 
Br J Gen Pract. May 1, 2006; 56(526): 369–374.
PMCID: PMC1837846
Limited impact on endoscopy demand from a primary care based ‘test and treat’ dyspepsia management strategy: the results of a randomised controlled trial
Ian S Shaw, MSc, MRCP, Consultant Gastroenterologist
Health Protection Agency Primary Care Unit, Gloucestershire Royal Hospital, Gloucester
Roland M Valori, MD, FRCP, Consultant Gastroenterologist
Gloucestershire Royal Hospital, Gloucester
André Charlett, MSc, Statistician
Health Protection Agency Statistics Unit, London
Cliodna AM McNulty, FRCPath, Consultant Medical Microbiologist and Head
Health Protection Agency Primary Care Unit, Gloucestershire Royal Hospital, Gloucester
Address for correspondence Dr Ian Shaw, Consultant Gastroenterologist, Gloucestershire Royal Hospital, Gloucester GL1 3NN. E-mail: Ian.Shaw/at/glos.nhs.uk
Received January 21, 2002; Revised May 22, 2002; Accepted October 13, 2005.
Abstract
Background
Helicobacter pylori testing has been suggested as an alternative to endoscopy for young patients with dyspepsia. Secondary care studies have suggested that demand for endoscopy among this group could be reduced by up to 74%. However, the effect of H. pylori testing in the primary care setting, where the majority of dyspepsia is managed, is unclear.
Aim
To determine the effects of providing a H. pylori serology service for GPs upon demand for open access endoscopy.
Design of study
A prospective randomised controlled trial.
Setting
Forty-seven general practices in Gloucestershire.
Method
General practices were stratified by endoscopy referral rate and randomised into two groups. The intervention group was provided with access to H. pylori serology testing and encouraged to use it in place of endoscopy for patients aged under 55 years with dyspepsia. Endpoints were referral for endoscopy and serology use.
Results
There was a significant reduction in referrals for endoscopy in the intervention group compared to the control group: 18.8% (95% confidence interval = 5.0 to 30.6%; P = 0.009).
Conclusions
Providing GPs with H. pylori serology testing reduced demand for open access endoscopy, but by less than previous studies had predicted.
Keywords: dyspepsia, endoscopy, Helicobacter pylori, serology
Articles from The British Journal of General Practice are provided here courtesy of
Royal College of General Practitioners