***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 
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    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 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 BACKGROUND Guidelines recommend Helicobacter pylori ( HP ) testing and treatment for patients with a history of peptic ulcer disease ( PUD ) , assuming that PUD has been documented and that successful HP eradication would eliminate the need for further therapy and medical utilization . METHODS An open-label , r and omized controlled trial in a managed care setting evaluated the clinical outcome and costs of an HP test- and -treat ( T & T ) strategy in 650 patients receiving long-term acid suppression therapy for physician-diagnosed PUD . Patients were r and omized to T & T for HP ( n = 321 ) or to usual care ( n = 329 ) . Outcome measures included presence and severity of PUD symptoms , use of acid-reducing medication , and acid-peptic-related health care costs during 12-month follow-up . RESULTS Only 17 % of study participants had PUD confirmed by radiography or endoscopy ; only 38 % of the T & T group tested positive for HP . At 12 months , patients in the T & T group were less likely to report ulcerlike dyspepsia or use of acid-reducing medication ; however , 75 % of the T & T group used acid-reducing medication during the second half of the 12-month follow-up . In the 12 months after r and omization , the T & T group had higher total acid-peptic-related costs than the usual care group . CONCLUSIONS Most patients receiving long-term acid suppression therapy for physician-diagnosed PUD in community practice setting s are likely to have HP-negative , uninvestigated dyspepsia . Routine testing and treating for HP will not reduce acid-peptic-related costs and have only a modest ( though statistically significant ) effect in reducing clinical symptoms and use of acid-reducing medications Study objective : To compare two strategies for the evaluation and management of patients who have had acute dyspepsia for four days or more :  empiric high-dose antacid therapy combined with patient reassurance ( empiric care ) versus therapy based on prompt upper gastrointestinal radiography ( traditional care ) . Design : Prospect i ve , r and omized trial . The patients in the empiric care group were reassured that upper gastrointestinal radiography was not necessary and were subsequently treated with high-dose empiric antacid therapy ( 15–30 ml of high-potency antacid one and three hours after meals and at bedtime ) . The traditional care group received upper gastrointestinal radiography as part of the initial evaluation . Subsequent treatment was determined by individual physicians based on test results . Setting s : Fee-for-service , hospital-based primary care practice and Veteran ’s Administration medical center outpatient clinic . Patients : All patients were less than 70 years of age and without gastrointestinal bleeding , anemia , significant weight loss , or other specified symptoms of severe acid peptic disease . Fifty patients were r and omized to traditional care , and 51 to empiric care . Pre-r and omization clinical features were identical with the exception of sex distribution and baseline disability . Measurements and main results : After six months of follow-up , there were no significant differences in symptom scores , disability , satisfaction , and quality of life measures ( as measured by the Sickness Impact Profile scores ) between the two groups . Findings were unchanged when adjusted for sex , study site , alcohol consumption , and cigarette smoking . Of the radiographs obtained in the traditional care group , 13 ( 27 % ) showed duodenal ulcer disease , gastritis , or duodenitis . There were no serious complications of ulcer disease or therapy noted in either group . The average costs per patient associated with traditional care at one study site were greater , $ 286 versus $ 116 ( p<0.0001 ) . Conclusions : Select patients with dyspepsia receiving a combination of reassurance and empiric antacid therapy do as well as patients whose initial management strategy includes upper gastrointestinal radiography , at a substantially lower cost : To compare the relative efficacies of lansoprazole 15 mg o.m . and omeprazole 10 mg o.m . in relieving heartburn and epigastric pain in patients with acid‐related dyspepsia . In addition , the study compared the safety profiles of the two treatments BACKGROUND It is known that at least 90 % of duodenal ulcers are caused by infection with the bacterium Helicobacter pylori . Eradicating this organism usually results in complete resolution of the disease . Testing for H pylori was introduced relatively recently , and thus , many patients known to have uncomplicated peptic ulcer disease who continue to need long-term treatment with ulcer-healing drugs have never been tested for the infection or offered eradication therapy . In modern computerized practice s , this subgroup of patients can readily be identified by reference to morbidity and repeat prescribing data . Eradication of H pylori infection in this group of patients has great potential benefit for the individuals concerned as well as cost-saving benefit for the National Health Service . AIM The aim of this prospect i ve study was to determine whether it is worthwhile screening for and treating H pylori infection in patients in a general practice population with previously diagnosed duodenal ulcer disease taking ulcer-healing drugs long term . METHOD In 1994 , in a practice of 7100 patients , morbidity and repeat prescribing data were used to identify 40 patients ( 0.6 % ) with proven duodenal ulcer disease taking ulcer-healing medication long term and with uncertain H pylori status . Twenty-nine of the 40 subjects agreed to undergo serology testing for H pylori antibodies . Of 20 ( 69 % ) who were positive , 18 ( eight women , median age 63.8 years ) were given eradication therapy . Seventeen patients received omeprazole 40 mg once daily and amoxycillin 500 mg three times daily for 14 days with metronidazole 400 mg three times daily for the first 7 days ; for the remaining patient metronidazole was inadvertently omitted . [13C]Urea  breath testing was carried out at the local hospital at least one month after therapy to determine whether eradication treatment had been successful . Subjects were also personally followed up by telephone after 1 and 4 months to assess the success of treatment subjectively . RESULTS [13C]Urea breath testing showed that H pylori eradication was successful in all 17 patients ( 100 % ) who received the intended eradication regimen . Helicobacter pylori was not eradicated in the patient who received only omeprazole and amoxycillin . Four months after successful H pylori eradication , 13 of the 17 ( 76 % ) patients remained completely asymptomatic . Two of the four patients who had some recurrent dyspepsia had known gastro-oesophageal reflux and their ongoing symptoms after eradication therapy seemed , on close question ing , to be more attributable to this than to duodenal ulcer disease . CONCLUSION Testing for and eradication of H pylori is worthwhile in general practice in those patients with previous proven duodenal ulceration who need long-term ulcer-healing medication . The high rate of eradication of H pylori achieved with the regimen used in this study compares very favourably with that of other treatment regimens . However , in patients with duodenal ulcers there may be coexisting pathology , and H pylori eradication does not necessarily result in complete disappearance of dyspeptic symptoms . Thus , when monitoring the outcome of treatment it is important to assess improvement of symptoms as well as objective evidence of eradication To compare lansoprazole 30 mg daily with ranitidine 150 mg b.d . in the treatment of acid‐related dyspepsia in general practice OBJECTIVES : The Helicobacter pylori ( H. pylori ) “ test- and -treat ” strategy in uninvestigated dyspepsia is an effective alternative to prompt endoscopy . Our aims were to determine whether the combination of an educational session and availability of office-based H. pylori testing ( test- and -treat intervention [ TTI ] ) increases use of the test- and -treat strategy by primary care practitioners and whether it improves patient outcomes . METHODS : We conducted a 1-yr prospect i ve trial of patients with suspected peptic ulcer disease in six primary care centers , three with TTI and three design ated as usual care controls ( UCC ) . RESULTS 
    Output:
    
PPIs were significantly more effective than both H2RAs and antacids .
Proton pump inhibitor drugs ( PPIs ) are effective in the treatment of dyspepsia in these trials which may not adequately exclude patients with gastro-oesophageal reflux disease ( GORD ) .
The relative efficacy of histamine H2-receptor antagonists ( H2RAs ) and PPIs is uncertain .
Early investigation by endoscopy or H. pylori testing may benefit some patients with dyspepsia but is not cost effective as part of an overall management strategy