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Review: prompt endoscopy is not a cost effective strategy for initial management of dyspepsia

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 Q In patients with dyspepsia, how cost effective is initial management with prompt endoscopy compared with a test and treat approach for inducing resolution of symptoms?

Clinical impact ratings GP/FP/Primary care ★★★★★☆☆ IM/Ambulatory care ★★★★★☆☆ Gastroenterology ★★★★★☆☆


Embedded ImageData sources:

a randomised controlled trial (RCT) register established by the Dyspepsia Trials Collaborators’ Group supplemented by searches of the Cochrane database of RCTs and Medline (all up to December 2003).

Embedded ImageStudy selection and assessment:

RCTs that compared a prompt endoscopy strategy with a test and treat approach for the initial management of dyspepsia in adults in primary care or on first referral to secondary care, and reported relevant outcomes.

Embedded ImageOutcomes:

total dyspepsia symptom score, presence of dyspepsia, cost (in 2003 US dollars), and incremental net benefit at 12 months.


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  • For correspondence: Professor B C Delaney, University of Birmingham, Birmingham, UK. b.c.Delaney{at}

  • Source of funding: Primary Care Research Trust for Birmingham and Midlands Research Practices Consortium.