***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: Computer models of different strategies for the management of dyspepsia in primary care indicate that a ' test- and -treat ' approach is likely to be associated with the lowest costs and acceptable clinical outcomes . We present information on computer modelling studies and report the findings of a r and omised trial comparing a Helicobacter pylori test- and -treat strategy with referral to direct access endoscopy in the management of dyspepsia in general practice . We compared costs and clinical outcomes in patients managed for one year in study ( test- and -treat ) and control ( endoscopy ) practice s in south London . Patients aged less than 45 years presenting with persistent dyspepsia without alarm symptoms ( 141 study patients , 91 control patients ) were studied . In the one-year follow-up period there were 17 endoscopies in the study group : all the control patients underwent initial endoscopy and five further endoscopies were performed . None revealed peptic ulcer or cancer . Forty-three ( 30 % ) of the study patients compared with 16 ( 17 % ) of the controls were referred to hospital clinics ( p < 0.025 ) . The cost of management per patient for one year in the study group was 205.67 Pounds , compared with 404.31 Pounds in the control group ( p < 0.0001 ) . Clinical outcomes in both groups at one year were comparable . An H. pylori test- and -treat strategy for dyspeptic patients aged less than 45 , employing office-based serology testing , appears to be associated with substantially lower costs than initial endoscopy and with similar clinical outcomes Objective : To compare a Helicobacter pylori “ test and treat ” strategy with prompt endoscopy in young Asians with dyspepsia . Methods : A r and omised , prospect i ve study was carried out on uninvestigated dyspeptics aged < 45 years in a single ( academic ) primary care centre . Patients were r and omised to either a [13C]urea breath test ( UBT ) or prompt endoscopy ( oesophagogastroduodenoscopy ( OGD ) and followed-up for 12 months . Results : 432 patients ( mean ( SD ) age 30 ( 8) years , male 46 % , ethnicity : Malays 33.3 % , Chinese 30.6 % , Indians 34.7 % ) were r and omised to UBT ( n = 222 ) or OGD ( n = 210 ) . 387 ( 89.6 % ) patients completed the study . At 12 months , there was no difference in symptom change ( measured by the Leeds Dyspepsia Question naire ) between the two groups , but more patients were very satisfied ( 40.0 % vs 21.6 % , p<0.0001 ) in the OGD group . More additional endoscopy was performed in the UBT group ( 25 vs 10 , p = 0.03 ) , but medication consumption was higher in the OGD group ( proton pump inhibitor 3.6 ( 8.8 ) vs 2.0 ( 7.5 ) weeks , p<0.001 ; H2 receptor antagonist 5.3 ( 9.7 ) vs 3.9 ( 9.2 ) weeks , p = 0.017 ; prokinetics 1.4 ( 4.7 ) vs 0.4 ( 2.5 ) weeks , p<0.001 ) and no differences in medical consultation were noted . The median cost of the initial prompt endoscopy approach at 12 months was significantly higher than a “ test and treat ” strategy ( US$ 179.05 vs US$ 87.10 , p<0.0001 ) . Conclusion : A H pylori “ test and treat ” strategy is more cost-effective but less satisfying than prompt endoscopy in the management of young Asian patients with uncomplicated dyspepsia AIMS To prospect ively evaluate the effectiveness of the test- and -treat strategy in a large group of dyspeptic patients in clinical practice . METHODS Patients with ulcer-like dyspepsia , < 45 years , without alarm symptoms , were prospect ively studied . Helicobacter pylori infection was diagnosed with the 13C-urea-breath-test , and eradication or symptomatic treatment was prescribed accordingly . ' Symptomatic improvement ' was defined as the percentage of patients with a decrease of > or = 2 levels in the dyspepsia-severity-score or with no symptoms after treatment . Health status and use of health re sources were also assessed . Endoscopy was performed in therapeutic failures . RESULTS Out of 736 patients initially included , 422 received eradication , and 314 symptomatic therapy ; 87 % returned at 6 weeks and 67 % at 6 months . At 6 months , ' symptomatic improvement ' was achieved in 73 % and 54 % of the patients , in eradication and symptomatic groups , respectively ( p < .001 ) , and overall in 66 % . A reduction of 78 % in mean self- assessment visual analogical score was observed at 6 months . More than 50 % of patients were ' much better ' at control visits . Endoscopy ( 18 % ) and physician 's visits ( 13 % ) were the main health re sources used . No gastric or oesophageal cancer was diagnosed . CONCLUSION This large prospect i ve study shows that the test- and -treat strategy is effective and safe for management of dyspeptic patients in clinical practice OBJECTIVE --To investigate the association between gastric cancer and prior infection with Helicobacter pylori . DESIGN --Case-control comparison of prevalence of IgG antibodies to H pylori in blood sample s collected prospect ively , before diagnosis of gastric cancer in the cases . Presence of H pylori antibody ( greater than 10 micrograms IgG/ml ) determined by enzyme linked immunosorbent assay ( ELISA ) . SUBJECTS--29 men with a subsequent diagnosis of gastric cancer and 116 aged matched controls selected from over 22,000 middle aged men participating in two ongoing cohort studies ( the British United Provident Association study and the Caerphilly collaborative heart disease study ) , who had provided blood sample s during 1975 - 1982 . RESULTS --20 of the 29 cases ( 69 % ) and 54 of the 116 controls ( 47 % ) were positive for H pylori specific antibody . The median specific IgG concentration was significantly higher in the cases than controls ( 90 micrograms/ml v 3.6 micrograms/ml , p less than 0.01 ) . The estimated odds ratio for the risk of gastric cancer in those with a history of infection with H pylori was 2.77 ( 95 % confidence interval 1.04 to 7.97 , 2p = 0.039 ) . CONCLUSIONS --H pylori infection may be an important cause of gastric cancer ; between 35 % and 55 % of all cases may be associated with such an infection BACKGROUND The value of the " test- and -treat " strategy in the approach to dyspepsia has been evaluated only in a few secondary care studies . Most patients with dyspepsia , however , are treated by their primary care physician . This study evaluated the test- and -treat strategy in primary care . METHODS Patients consulting their general practitioners for dyspepsia were r and omized to either direct open-access endoscopy with Helicobacter pylori testing or a test- and -treat strategy by H pylori serology . In the 12-month follow-up period , any additional treatment or referral for investigations was left at the discretion of the general practitioner . At the end of the study , data were collected concerning the number of endoscopies , changes in symptom severity and quality of life , patient satisfaction , and the use of medical re sources . RESULTS Two hundred seventy patients were enrolled ( 129 who received endoscopy and 141 in the test- and -treat group ) . The prevalence of H pylori infection was 38.3 % and 37.2 % in the test- and -treat and endoscopy groups , respectively . In the test- and -treat group , 46 patients ( 33 % ) were referred for endoscopy during follow-up . Improvement in symptom severity , quality of life , and patient satisfaction was comparable in both groups . Patients in the test- and -treat group paid more dyspepsia-related visits to their general practitioner ( P = .005 ) . Patients in the endoscopy group were more often prescribed  proton pump inhibitors ( P = .007 ) , whereas patients in the test- and -treat group were more often prescribed  prokinetic drugs  ( P = .005 ) . CONCLUSIONS The test- and -treat strategy proved to be as effective and safe as prompt endoscopy . Only a minority of patients were referred for endoscopy after the test- and -treat approach Abstract Objective To compare the efficacy of a “ Helicobacter pylori test and treat ” strategy with that of an empirical trial of omeprazole in the non-endoscopic management by empirical prescribing of young patients with dyspepsia . Design R and omised controlled trial . Setting Hospital gastroenterology unit . Participants 219 patients under 45 years old presenting with dyspepsia without alarm symptoms . Intervention Patients received treatment with omeprazole 20 mg ( group A ) or with a urea breath test followed by an eradication treatment in case of H pylori infection or omeprazole alone in non-infected patients ( group B ) . Lack of improvement or recurrence of symptoms prompted endoscopy . Main outcome measures Improvement in symptoms assessed by a dyspepsia severity score every two months ; use of medical re sources ( endoscopic workload and medical consultation ) ; clinical outcome . Results 96/109 ( 88 % ) patients in group A and 61/110 ( 55 % ) in group B ( P < 0.0001 ) had endoscopy : in 19 patients in group A and 32 in group B ( 20/67 infected and 12/43 non-infected ) because of no improvement ; in 77 further patients in group A and 29 in group B ( 7 infected and 22 non-infected ) because of recurrence of symptoms during follow up . Endoscopy showed peptic ulcers only in group A ; oesophagitis occurred significantly more often in group B than in group A. About 80 % of examinations were normal in both groups , but nine duodenal scars occurred in group A. Conclusions Eradication treatment allows resolution of symptoms in a large number of patients with dyspepsia and reduces the endoscopic workload . After a trial of omeprazole , symptoms recur in nearly every patient . Such treatment is also likely to mask an appreciable number of peptic ulcers and cases of oesophagitis Introduction The respective roles of general practitioners and specialists in the management of most diseases is not clearly defined and dyspepsia is no exception . Ideally , the division of tasks should be based on the characteristics of diVerent diseases and on specific objectives . The prevalence of dyspepsia ranges between 20 and 40 % in industrialised countries and roughly 25 % of patients seek medical help , whereas the remainder often self-medicate . Although frequently idiopathic ( or functional ) , dyspepsia can be secondary to a variety of serious ( and sometimes fatal ) organic , systemic and metabolic diseases that need to be identified . Functional dyspepsia also precipitates a substantial reduction in the quality of life of aVected patients with relevant costs for society . The current economic restrictions prevent referral of every patient and correct management of dyspepsia is a formidable task . Prospect i ve studies have been undertaken to establish the respective eVectiveness of diVerent doctors in the management of some gastroenterological diseases . Zarling et al compared the eYcacy of management of acute diverticulitis provided by general practitioners , internists and gastroenterologists , and observed shorter hospital stay and lower readmission rates in patients treated by gastroenterlogists . Unlike acute diverticulitis , dyspepsia is a very heterogeneous condition and no similar studies are available as yet . Tackling the following questions may help to eluci date the remit of diVerent doctors . + What drives a dyspeptic individual to consult a physician ? + Do diVerent doctors see diVerent types of dyspeptic patients  ? + What is the diagnostic yield of an extensive work-up by a specialist ? + Should diVerent doctors adopt diVerent strategies for the management of dyspepsia ? + What is the most cost-eVective way to manage dyspepsia Objective : The diagnostic value of the addition of alarm symptoms in distinguishing functional from organic gastrointestinal disease remains uncertain . We aim ed to establish the value of alarm features in differentiating between organic disease and irritable bowel syndrome ( IBS ) and functional dyspepsia ( FD ) . Methods : A total of 568 consecutive patients ( 63 % female ; mean age 44.7 years ) completed a detailed symptom question naire and then received a complete diagnostic workup , as required . Question naire data were collected prospect ively and audited retrospectively ; the treating physician was blinded to the results of the question naires . Patients were coded and allocated to the following diagnostic groups : IBS , FD , organic diseases of the upper gastrointestinal tract , or organic diseases of the lower gastrointestinal tract . Logistic regression was used to identify the best subset of symptoms that discriminated organic disease from functional illness . Separate models compared IBS ( n = 214 ) with diseases of the lower gastrointestinal tract ( n = 66 ) , and FD ( n = 70 ) with diseases of the upper gastrointestinal tract ( n = 
    Output:
    
The test- and -treat strategy will cure most cases of underlying peptic ulcer disease , prevent most potential cases of gastroduodenal disease , and yield symptomatic benefit in a minority of patients with functional dyspepsia .
: The test- and -treat strategy will cure most cases of underlying peptic ulcer disease and prevent most potential cases of gastroduodenal disease .
In addition , a minority of infected patients with functional dyspepsia will gain symptomatic benefit .