A randomized trial of endoscopy vs no endoscopy in the management of seronegative Helicobacter pylori dyspepsia

Background It is unclear whether endoscopy influences the management of Helicobacter pylori negative dyspepsia. Aim To determine whether endoscopy alters health-care resource utilization, quality of life and symptom outcome in H. pylori seronegative dyspeptic patients aged under 45 years; and to determine which factors predict outcome of symptoms. Method One hundred and fifty-four H. pylori seronegative subjects were randomized to have an endoscopy or no endoscopy before subsequent management by their Gps. Assessment was carried out at 6 months and supplementary information obtained at 12 months. Results There was no significant difference between the two groups for progression of dyspeptic symptoms (better, same and worse) at 6 months (47%, 46%, 7% vs 43%, 52%, 5%), and at 12 months (55%, 34%, 11% vs 57%, 28%, 15%). Prescriptions were lower in both groups at 6 and 12 months than on entry into the study, independent of endoscopy, Endoscopy did not influence quality of life, visits to GPs and days lost from work. Prognostic factors for symptom resolution at 6 months were lower severity of initial symptoms, non-smoking, non-Caucasians, less anxious patients and those not on acid suppressants. Conclusions H. pylori negative dyspeptic patients aged under 45 years without sinister symptoms could be managed without the need of an endoscopy, Eur J Gastroenterol Hepatol 10: 983-989 (C) 1998 Lippincott Williams & Wilkins.