***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background In August 2004 , the United Kingdom Department of Health advisory body published dyspepsia referral guidelines for primary care practitioners . These guidelines advised empiric treatment with antisecretory medications and referral for endoscopy only in the presence of alarm symptoms . The current study aim ed to evaluate the effect of these guidelines on the detection of esophagogastric cancer . Methods The study review ed a prospect ively compiled data base of 4,018 subjects who underwent open access gastroscopy during the years 1990 to 1998 . The main outcome measures for the study were cancer detection rates , International Union Against Cancer ( UICC ) stage , and survival . Results Gastroscopy identified esophagogastric carcinoma in 123 ( 3 % ) of the 4,018 subjects . Of these 123 patients , 104 ( 85 % ) with esophagogastric cancer had “ alarm ” symptoms ( anemia , mass , dysphagia , weight loss , vomiting ) and would have satisfied the referral criteria . The remaining 15 % would not have been referred for initial endoscopic assessment because their symptoms were those of uncomplicated “ benign ” dyspepsia . The patients with “ alarm ” symptoms had a significantly more advanced tumor stage ( metastatic disease in 47 % vs 11 % ; p < 0.001 ) , were less likely to undergo surgical resection ( 50 % vs 95 % ; p < 0.001 ) , and had a poorer survival ( median , 11 vs 39 months ; p = 0.01 ) than their counterparts without such symptoms . Conclusions The use of alarm symptoms to select dyspeptics for endoscopy identifies patients with advanced and usually incurable esophagogastric cancer . Patients with early curable cancers often have only dyspeptic symptoms , and their diagnosis will be delayed until the symptoms of advanced cancer develop One hundred r and omly selected in patients were examined with both double-contrast barium meal and endoscopy in a blinded prospect i ve fashion . All studies were done by staff personnel , with equal clinical information available to both the radiologist and endoscopist . The final diagnosis was made by a review committee of participating radiologists and endoscopists . Endoscopy was more sensitive ( 92 % versus 54 % , p less than 0.001 ) and specific ( 100 % versus 91 % , p less than 0.05 ) than the double-contrast barium meal . Both procedures significantly affected the clinical outcome of the patient , the effect of endoscopy being significantly greater than that of the double-contrast barium meal . Although errors with the barium study related predominantly to an inability to show subtle lesions , poor patient cooperation and perceptual and technical failures were additional significant factors . Endoscopy is recommended for certain groups of patients This study assessed the screening rates for gastric cancer by two different screening methods , upper gastrointestinal ( UGI ) series and endoscopy ; intentions to undergo future gastric cancer screening ; and the preferred method of screening . The study population was derived from the 2006 Korean National Cancer Screening Survey . The Korean National Cancer Screening Survey is an annual cross-sectional survey that uses nationally representative r and om sampling to investigate cancer screening rates . A total of 1,625 Koreans over 40 years of age participated in this study .  Logistic regression  was used to identify the factors associated with undergoing gastric  cancer screening  , having an intention to be screened , and preferring one of the two screening tests . Among the 1,625 subjects , 15.1 % had received a UGI , 33.2 % had received an endoscopy , and 43.1 % had undergone either or both of the tests in the previous 2 years . About 52 % of people reported the intention to be screened within the next 2 years . The odds ratio for intending to be screened was 11.8 and 6.2 higher among those who had undergone a prior UGI test and an endoscopy test within the previous 2 years , respectively , than for those who had never been screened . Among the 1,625 individuals , 67 % chose  endoscopy  and 33 %  UGI  for their preferred future screening method . Collectively , our results highlight the preference for  endoscopy testing as a gastric cancer screening method . Providers ' assessment s of individuals ' screening preferences in combination with intervention strategies to promote performance of the preferred test may increase patient compliance with gastric cancer screening recommendations . ( Cancer Epidemiol Biomarkers Prev 2009;18(5):1390–8 Background / Aims Gastroesophageal reflux disease ( GERD ) is increasing in Asian countries . Functional dyspepsia ( FD ) or irritable bowel syndrome ( IBS ) are also prevalent and commonly overlapped with GERD . This study was conducted to compare the proportion and risk factors for overlapping reflux esophagitis ( RE ) and non-erosive reflux disease ( NERD ) with functional gastrointestinal disorders ( FGIDs ) . Methods A total of 2,388 [ male , 55.9 % ; mean age ( ± SD ) , 43.2 years ( ± 8.4 ) ] Korean subjects who underwent the upper endoscopy for health screening were prospect ively included . The subjects were asked about demographic , medical and social history by using a structured question naire , and FD and IBS were assessed according to the Rome III criteria . Results The subjects with RE were 286 ( 12.0 % , male 88.5 % , 42.8 years ) and 74 subjects had NERD ( 3.1 % ) while the prevalence of FD and IBS were 8.1 % and 10.1 % , respectively . The proportion of FD and IBS in NERD was higher than that of RE ( 74.3 % vs. 10.5 % , p = 0.000 ; 41.9 % vs. 11.2 % , p = 0.000 , respectively ) . The epigastric pain syndrome ( EPS ) was more prevalent than postpr and ial distress syndrome in NERD . According to multiple regression analysis , high somatization score and the presence of FD increased the odd ratio for NERD . However , male gender and current smoker were significant risk factors for RE . Conclusions Compared to RE , NERD is more frequently overlapped with FD , especially EPS , and also are associated with significantly increased frequency of IBS . Our data draws attention to the possibility of subgrouping FGIDs and GERD to be important in underst and ing the pathophysiology of these conditions BACKGROUND Management of dyspepsia remains a controversial area . Although the EuropeanHelicobacter pylori study group has advised empirical eradication therapy without oesophagogastroduodenoscopy ( OGD ) in young H pylori positive dyspeptic patients who do not exhibit alarm symptoms , this strategy has not been subjected to clinical trial . AIMS To compare a “ test and treat ” eradication policy against management by OGD . PATIENTS Consecutive subjects were prospect ively recruited from open access OGD and outpatient referrals . METHODS H pylori status was assessed using the carbon-13 urea breath test .  H pylori positive patients were r and omised to either empirical eradication or OGD .  Symptoms and quality of life scores were assessed at baseline and subsequent review s over a 12 month period . RESULTS A total of 104H pylori positive patients aged under 45 years were recruited . Fifty two were r and omised to receive empirical eradication therapy and 52 to OGD . Results were analysed using an intention to treat policy . Dyspepsia scores significantly improved in both groups over 12 months compared with baseline ; however , dyspepsia scores were significantly better in the empirical eradication group . Quality of life showed significant improvements in both groups at 12 months ; however , physical role functioning was significantly improved in the empirical eradication group . Fourteen ( 27 % ) in the empirical eradication group subsequently proceeded to OGD because of no improvement in dyspepsia . CONCLUSIONS This r and omised study strongly supports the use of empirical H pylori eradication in patients referred to secondary practice ; it is estimated that 73 % of OGDs in this group would have been avoided with no detriment to clinical outcome Abstract Objective : To determine the cost effectiveness of a strategy of near patient Helicobacter pylori testing and endoscopy for managing dyspepsia . Design : R and omised controlled trial . Setting : 31 UK primary care centres . Participants : 478 patients under 50 years old presenting with dyspepsia of longer than four weeks duration . Interventions : Near patient testing for H pylori and open access endoscopy for patients with positive results . Control patients received acid suppressing drugs or specialist referral at general practitioner 's discretion . Main outcome measures : Cost effectiveness based on improvement in symptoms and use of re sources at 12 months ; quality of life . Results : 40 % of the study group tested positive for H pylori . 45 % of study patients had endoscopy compared with 25 % of controls . More peptic ulcers were diagnosed in the study group ( 7.4 % v 2.1 % , P=0.011 ) . Paired comparison of symptom scores and quality of life showed that all patients improved over time with no difference between study and control groups . No significant differences were observed in rates of prescribing , consultation , or referral . Costs were higher in the study group ( £ 367.85 v £ 253.16 per patient ) . Conclusions : The test and endoscopy strategy increases endoscopy rates over usual practice in primary care . The additional cost is not offset by benefits in symptom relief or quality of life . What is already known on this topic Patients younger than 50 without H pylori infection are unlikely to have treatable disease detected at endoscopy Such patients can be managed by acid suppression and reassurance alone Test and endoscopy ( referral of patients testing positive for H pyloriin primary care ) has been recommended as a way to reduce endoscopic workload What this paper adds Applying a test and endoscopy strategy increased the endoscopy referral rate from 25 % to 40 % The strategy produced no significant differences in symptoms or quality of life compared with usual management The increased costs of this strategy can not be BACKGROUND AND AIMS : Helicobacter pylori ( H. pylori ) screening and eradication may reduce the incidence of gastric cancer , peptic ulcer , and ulcer complications , and it may reduce symptoms in a small proportion of individuals with functional dyspepsia . This study aim ed to assess the effect of community H. pylori screening and treatment on the prevalence of dyspepsia , and as secondary outcomes , the effect on dyspepsia-related health-care consumption and quality of life over 5 yr . METHODS : In 1998–1999 , individuals aged 40–65 yr were r and omized to H. pylori screening and treatment or to the control group .  Five years later , the participants were sent a question naire to assess the prevalence of dyspepsia and quality of life . In addition , we obtained information from registers on the use of endoscopies and prescription medication . An economic evaluation was done alongside the r and omized trial . RESULTS : Of 12,530 participants attending the study at baseline , 11,065 ( 88 % ) were traced and contacted at the 5-yr follow-up . The response rate was 94 % . At baseline , 17.5 % in the screened group were H. pylori-positive . The absolute reduction in dyspepsia during the first year was 4 % in the screened group , whereas no change was observed in the unscreened group ; this rate remained constant during the next 4 yr . Quality of life did not change . A small effect was found for dyspepsia-related consultations and sick leave days , but not on the prescription rate of ulcer drugs . A 33 % lower ulcer incidence ( 107 ulcers vs 148 ulcers ) was seen in the screened group compared to the unscreened group . CONCLUSION : A population H. pylori screening and treatment program in an H. pylori low-prevalence area had only a modest , but insignificant , effect on the rate of dyspepsia , and a modest , significant effect on the consultation rate and sick leave days for dyspepsia , but result ed in a decreased ulcer incidence . The intervention result ed in an increased cost due to H. pylori screening and treatment This study examines the preference of 64 out- patients for either a barium meal or an upper gastrointestinal endoscopy .  The sequence of the examinations was r and omized to avoid order bias . An initial preference for a barium meal of almost two-to-one , with 53 % having no preference , was changed after the investigations to a preference for endoscopy of two-to-one with 5 % having no preference . The use of mild sedation and the skill of the endoscopist had a major impact on the patients ' opinion of the endoscopic procedure , and on their choice of examination for any repeat study . There was little agreement between clinical diagnosis and the result of investigation , but clinicians tended to accept the reported result of the investigation , especially if the result was abnormal . Despite a change in diagnosis in 34 of 49 patients there was little change in management as a result of the investigations , supporting the view that young patients with dyspepsia may be managed with symptomatic treatment initially , and without investigation . This study lends further support to the view that endoscopy should be the investigation of choice in patients with persistent dyspepsia , especially those whose age or infirmity may make barium examination suboptimal INTRODUCTION Guidelines for an upper gastrointestinal endoscopy have been outlined for the Western population , but not yet for India . The study aim ed to assess 
    Output:
    
The evidence concerning alarm features does not allow clear guideline whether early endoscopy should be performed or not .
Therefore , ' H. pylori test and treatment ' strategy is not suitable for the initial diagnostic approach for uninvestigated dyspepsia .
There have been a lot of evidence s showing that early upper GI endoscopy  might be more effective than empirical medication , which is different from Western countries .
However , cut-off age for early endoscopy is not clear , especially in case of young age .