Abstract：
BACKGROUND & AIMS:Empirical therapy has been proposed for initial management of dyspepsia. The aim of this study was to evaluate initial endoscopy, empirical therapy, and testing for Helicobacter pylori in the management of patients with a new onset of dyspepsia. METHODS:Decision analysis was used to compare the direct medical charges in the first year after the onset of dyspepsia for patients managed by initial endoscopy or empirical therapy, with or without initial testing for H. pylori. RESULTS:Medical care charges were $2162.50 for initial endoscopy and $2122.60 for empirical therapy, a difference of 1.8%. For a 55-year-old adult, life expectancy was 23.49 years for initial endoscopy compared with 23.48 years for empirical therapy. Empirical therapy has lower charges than initial endoscopy when H2-receptor antagonists are used to prevent recurrence of dyspepsia. Initial noninvasive testing for H. pylori has lower charges than initial endoscopy if patients with dyspepsia with H. pylori receive antimicrobial therapy without endoscopy but would have higher charges if patients with H. pylori routinely have endoscopy. CONCLUSIONS:Surprisingly, the choice of optimal management strategy was a "toss-up." Only modest savings may result from practice guidelines that recommend empirical therapy in the management of patients with dyspepsia.
journal_name
Gastroenterologyjournal_title
Gastroenterologyauthors
Silverstein MD,Petterson T,Talley NJdoi
10.1053/gast.1996.v110.pm8536890subject
Has Abstractpub_date
1996-01-01 00:00:00pages
72-83issue
1eissn
0016-5085issn
1528-0012pii
S0016508596000455journal_volume
110pub_type
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