THERAPEUTICS
Step-up and step-down treatment strategies did not differ for symptom relief at 6 months in new onset dyspepsia
| The first 150 words of the full text of this article appear below. |
STUDY DESIGN
randomised controlled trial (Dutch study on Initial Management Of Newly diagnosed Dyspepsia [DIAMOND]). ClinicalTrials.gov NCT00247715 [ClinicalTrials.gov] .
concealed.*
blinded (patients, {investigators, and study personnel}
).*
STUDY QUESTION
312 primary care physician practices in the Netherlands.
664 patients 
18 years of age (54% women) who visited their general practitioner for new onset dyspepsia (pain or discomfort in upper abdomen and originating in upper gastrointestinal tract). Exclusion criteria included gastroscopy in the past year, use of prescribed acid suppressive medication in the past 3 months, alarm symptoms (dysphagia, weight loss, anaemia, or haematemesis), pregnancy, or insufficient knowledge of Dutch.
step-up treatment (n = 341) given in 3 four-week steps: (1) antacid (aluminium oxide, 200 mg/magnesium hydroxide, 400 mg) 4 times/day, plus placebo once daily; (2) H2-receptor agonist (ranitidine, 150 mg) twice daily; and (3) proton pump inhibitor (PPI; pantoprazole, 40 mg) once daily, plus placebo 4 times/daily. For step-down treatment, steps were reversed (n
Mayo Clinic Florida Jacksonville, Florida, USA
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