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Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
Br J Gen Pract. 2006 May 1; 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



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.


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.


Forty-seven general practices in Gloucestershire.


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.


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).


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