Résumé :
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[BDSP. Notice produite par INIST P3e7iR0x. Diffusion soumise à autorisation]. Background Strategies based on screening for Helicobacter pylori to manage dyspeptic patients in primary care have been proposed, but the clinical consequences are unclear. We did a randomised trial to assess the efficacy and safety of a test-and-eradicate strategy compared with prompt endoscopy in the management of patients with dyspepsia. Methods 500 patients presenting in primary care with dyspepsia (>=2 weeks of epigastric pain, no alarm symptoms) were assigned H pylori testing plus eradication therapy or endoscopy. Symptoms, quality of life, patients'satisfaction, and use of resources were recorded during 1 year of follow-up. Findings 250 patients were assigned test-and-eradicate, and 250 prompt endoscopy. The median age was 45 years and 28% were H pylori infected. 1 year follow-up was completed by 447 patients. We found no differences in symptoms between the two groups (median registered days without dyspeptic symptoms=0.63 [IQR 0.27-0.81] in the test-and-eradicate group vs 0.67 [0.36-0.86] in the prompt endoscopy group ; mean difference 0.04 [95% Cl - 0.01-0.10], p=0.12). Nor did we find any difference in quality of life or numbers of sick-leave days, visits to general practitioners, or hospital admissions. In the test-and-eradicate group, 27 (12%) of the patients were dissatisfied with management, compared with eight (4%) in the endoscopy group (p=0.013). After 1 year, the use of endoscopies in the test-and-eradicate group was 0.40 times (95% Cl 0.31-0. (...)
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