Scolaris Content Display Scolaris Content Display

Comparison 1 Acid suppression ‐ internal comparisons, Outcome 1 PPI vs. Antacid/alginate.
Figures and Tables -
Analysis 1.1

Comparison 1 Acid suppression ‐ internal comparisons, Outcome 1 PPI vs. Antacid/alginate.

Comparison 1 Acid suppression ‐ internal comparisons, Outcome 5 PPI vs. H2 Receptor antagonist.
Figures and Tables -
Analysis 1.5

Comparison 1 Acid suppression ‐ internal comparisons, Outcome 5 PPI vs. H2 Receptor antagonist.

Comparison 1 Acid suppression ‐ internal comparisons, Outcome 7 H2 receptor antagonist vs. antacid/alginate.
Figures and Tables -
Analysis 1.7

Comparison 1 Acid suppression ‐ internal comparisons, Outcome 7 H2 receptor antagonist vs. antacid/alginate.

Comparison 1 Acid suppression ‐ internal comparisons, Outcome 9 Lansoprazole 15mg vs. Omeprazole 10mg.
Figures and Tables -
Analysis 1.9

Comparison 1 Acid suppression ‐ internal comparisons, Outcome 9 Lansoprazole 15mg vs. Omeprazole 10mg.

Comparison 2 Initial endoscopy vs. empirical management, Outcome 1 Dyspepsia symptom scores.
Figures and Tables -
Analysis 2.1

Comparison 2 Initial endoscopy vs. empirical management, Outcome 1 Dyspepsia symptom scores.

Comparison 2 Initial endoscopy vs. empirical management, Outcome 2 Individual symptoms‐ epigastric pain.
Figures and Tables -
Analysis 2.2

Comparison 2 Initial endoscopy vs. empirical management, Outcome 2 Individual symptoms‐ epigastric pain.

Comparison 2 Initial endoscopy vs. empirical management, Outcome 3 Individual symptoms ‐ heartburn.
Figures and Tables -
Analysis 2.3

Comparison 2 Initial endoscopy vs. empirical management, Outcome 3 Individual symptoms ‐ heartburn.

Comparison 2 Initial endoscopy vs. empirical management, Outcome 4 Global assessment of dyspepsia (primary outcome).
Figures and Tables -
Analysis 2.4

Comparison 2 Initial endoscopy vs. empirical management, Outcome 4 Global assessment of dyspepsia (primary outcome).

Comparison 2 Initial endoscopy vs. empirical management, Outcome 5 Quality of life scores.
Figures and Tables -
Analysis 2.5

Comparison 2 Initial endoscopy vs. empirical management, Outcome 5 Quality of life scores.

Comparison 2 Initial endoscopy vs. empirical management, Outcome 6 Patient satisfaction.
Figures and Tables -
Analysis 2.6

Comparison 2 Initial endoscopy vs. empirical management, Outcome 6 Patient satisfaction.

Comparison 2 Initial endoscopy vs. empirical management, Outcome 7 Satisfaction score.
Figures and Tables -
Analysis 2.7

Comparison 2 Initial endoscopy vs. empirical management, Outcome 7 Satisfaction score.

Comparison 3 H. pylori test and endoscopy vs. empirical therapy, Outcome 1 Dyspepsia symptom scores.
Figures and Tables -
Analysis 3.1

Comparison 3 H. pylori test and endoscopy vs. empirical therapy, Outcome 1 Dyspepsia symptom scores.

Comparison 3 H. pylori test and endoscopy vs. empirical therapy, Outcome 2 Quality of life.
Figures and Tables -
Analysis 3.2

Comparison 3 H. pylori test and endoscopy vs. empirical therapy, Outcome 2 Quality of life.

Comparison 3 H. pylori test and endoscopy vs. empirical therapy, Outcome 3 Global assessment of dyspepsia (primary outcome).
Figures and Tables -
Analysis 3.3

Comparison 3 H. pylori test and endoscopy vs. empirical therapy, Outcome 3 Global assessment of dyspepsia (primary outcome).

Comparison 4 H. pylori test and treat vs. initial endoscopy, Outcome 1 Dyspepsia symptom scores.
Figures and Tables -
Analysis 4.1

Comparison 4 H. pylori test and treat vs. initial endoscopy, Outcome 1 Dyspepsia symptom scores.

Comparison 4 H. pylori test and treat vs. initial endoscopy, Outcome 2 Global assessment of dyspepsia (primary outcome).
Figures and Tables -
Analysis 4.2

Comparison 4 H. pylori test and treat vs. initial endoscopy, Outcome 2 Global assessment of dyspepsia (primary outcome).

Comparison 4 H. pylori test and treat vs. initial endoscopy, Outcome 5 IPD dichotomous symptom scores.
Figures and Tables -
Analysis 4.5

Comparison 4 H. pylori test and treat vs. initial endoscopy, Outcome 5 IPD dichotomous symptom scores.

Comparison 4 H. pylori test and treat vs. initial endoscopy, Outcome 6 Proportion of patients endoscoped.
Figures and Tables -
Analysis 4.6

Comparison 4 H. pylori test and treat vs. initial endoscopy, Outcome 6 Proportion of patients endoscoped.

Comparison 4 H. pylori test and treat vs. initial endoscopy, Outcome 7 IPD Incremental Net Benefit.
Figures and Tables -
Analysis 4.7

Comparison 4 H. pylori test and treat vs. initial endoscopy, Outcome 7 IPD Incremental Net Benefit.

Comparison 5 H. pylori test and treat vs. acid suppression/placebo, Outcome 1 Global assessment of dyspepsia (primary outcome).
Figures and Tables -
Analysis 5.1

Comparison 5 H. pylori test and treat vs. acid suppression/placebo, Outcome 1 Global assessment of dyspepsia (primary outcome).

Comparison 5 H. pylori test and treat vs. acid suppression/placebo, Outcome 2 Endoscopies.
Figures and Tables -
Analysis 5.2

Comparison 5 H. pylori test and treat vs. acid suppression/placebo, Outcome 2 Endoscopies.

Table 1. Case mix in primary care dyspepsia trials

Study

Included

Excluded

Likely case mix

Details given

Goves

Heartburn, epigastric pain

Any organic diagnosis

Uninvestigated, Non‐ulcerdyspepsia, ENRD

95% had some reflux symptoms.

Mason

Heartburn, epigastric pain

Any organic diagnosis

Uninvestigated, Non‐ulcerdyspepsia, ENRD

93% had heartburn

Meimiche‐Schmidt 1997

Reflux like, Ulcer like by symptom pattern scoring

Group A ‐ Not investigated or no abnormality on endoscopy. Group B, Proven Peptic ulcer or oesophagitis

Group A Peptic ulcer, oesophagitis, Group B Uninvestigated, Non‐ulcer dyspepsia, ENRD.

Nil

Paton

Reflux like

Ulcer like only, Peptic ulcer or oesophageal stricture/ Barratt's.

ENRD, Oesophagitis

Nil

Jones 1997

Reflux like, Ulcer Like

None

All cases

25% ulcer like alone, 61% reflux like alone, 14% both. 27 cases of duodenal ulcer, 58 of proven oesophagitis.

Jones 1999a

Mild reflux or ulcer like symptoms

Peptic ulcer, Oesophagitis

Non ulcer, ENRD, uninvestigated

Ulcer like alone 15%, Reflux like alone 28%, both 57%.

Figures and Tables -
Table 1. Case mix in primary care dyspepsia trials
Comparison 1. Acid suppression ‐ internal comparisons

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 PPI vs. Antacid/alginate Show forest plot

4

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 Global assessment of dyspepsia (primary outcome)

4

2154

Risk Ratio (M‐H, Random, 95% CI)

0.65 [0.54, 0.78]

1.2 Heartburn

2

1118

Risk Ratio (M‐H, Random, 95% CI)

0.52 [0.45, 0.60]

1.3 Epigastric pain

3

1267

Risk Ratio (M‐H, Random, 95% CI)

0.80 [0.63, 1.02]

1.4 Patient satisfaction

1

658

Risk Ratio (M‐H, Random, 95% CI)

0.30 [0.25, 0.37]

1.5 Withdrawals due to adverse events

1

828

Risk Ratio (M‐H, Random, 95% CI)

1.47 [0.15, 14.04]

5 PPI vs. H2 Receptor antagonist Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 Global assessment of dyspepsia (Primary outcome)

3

1267

Risk Ratio (M‐H, Fixed, 95% CI)

0.64 [0.58, 0.72]

5.2 Epigastric pain

3

1222

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.58, 0.81]

5.3 Heartburn

3

1223

Risk Ratio (M‐H, Fixed, 95% CI)

0.46 [0.37, 0.57]

5.4 Patient satisfaction

1

558

Risk Ratio (M‐H, Fixed, 95% CI)

0.28 [0.21, 0.37]

7 H2 receptor antagonist vs. antacid/alginate Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 Global assessment of dyspepsia (primary outcome)

1

255

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.78, 1.24]

7.3 Heartburn

1

163

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.35, 2.11]

9 Lansoprazole 15mg vs. Omeprazole 10mg Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 Global assessment

1

562

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.69, 1.00]

Figures and Tables -
Comparison 1. Acid suppression ‐ internal comparisons
Comparison 2. Initial endoscopy vs. empirical management

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Dyspepsia symptom scores Show forest plot

2

694

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.08 [‐0.23, 0.07]

2 Individual symptoms‐ epigastric pain Show forest plot

1

373

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.70, 1.09]

3 Individual symptoms ‐ heartburn Show forest plot

1

373

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.73, 1.19]

4 Global assessment of dyspepsia (primary outcome) Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 Proportion of patients 'not improved'

4

1125

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.77, 1.02]

4.2 Proportion of days with symptoms

1

521

Risk Ratio (M‐H, Fixed, 95% CI)

1.00 [0.80, 1.25]

5 Quality of life scores Show forest plot

2

690

Std. Mean Difference (IV, Fixed, 95% CI)

0.09 [‐0.06, 0.24]

6 Patient satisfaction Show forest plot

1

373

Risk Ratio (M‐H, Fixed, 95% CI)

0.13 [0.06, 0.29]

7 Satisfaction score Show forest plot

1

Std. Mean Difference (IV, Fixed, 95% CI)

Subtotals only

7.1 Primary care

1

297

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.23, 0.23]

7.2 Secondary care

1

171

Std. Mean Difference (IV, Fixed, 95% CI)

0.16 [‐0.17, 0.48]

7.3 Endoscopy

1

163

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.39 [‐0.73, ‐0.04]

Figures and Tables -
Comparison 2. Initial endoscopy vs. empirical management
Comparison 3. H. pylori test and endoscopy vs. empirical therapy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Dyspepsia symptom scores Show forest plot

1

289

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.13 [‐0.37, 0.11]

2 Quality of life Show forest plot

1

288

Std. Mean Difference (IV, Fixed, 95% CI)

0.19 [‐0.05, 0.43]

3 Global assessment of dyspepsia (primary outcome) Show forest plot

3

686

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.84, 1.06]

Figures and Tables -
Comparison 3. H. pylori test and endoscopy vs. empirical therapy
Comparison 4. H. pylori test and treat vs. initial endoscopy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Dyspepsia symptom scores Show forest plot

2

690

Std. Mean Difference (IV, Random, 95% CI)

‐0.14 [‐0.58, 0.31]

2 Global assessment of dyspepsia (primary outcome) Show forest plot

5

1682

Risk Ratio (M‐H, Random, 95% CI)

0.95 [0.79, 1.15]

5 IPD dichotomous symptom scores Show forest plot

5

Peto Odds Ratio (95% CI)

Subtotals only

5.1 All patients

5

1924

Peto Odds Ratio (95% CI)

0.75 [0.58, 0.96]

5.2 Age under 50

5

1454

Peto Odds Ratio (95% CI)

0.79 [0.58, 1.06]

5.3 Age over 50

4

470

Peto Odds Ratio (95% CI)

0.62 [0.40, 0.97]

5.4 Heartburn predominant

2

366

Peto Odds Ratio (95% CI)

0.80 [0.35, 1.84]

5.5 Epigastric pain predominant

2

563

Peto Odds Ratio (95% CI)

0.80 [0.52, 1.23]

6 Proportion of patients endoscoped Show forest plot

5

1845

Risk Ratio (M‐H, Random, 95% CI)

0.25 [0.15, 0.40]

7 IPD Incremental Net Benefit Show forest plot

5

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

7.1 Willingness to Pay = $0

5

1771

Mean Difference (IV, Fixed, 95% CI)

401.69 [328.64, 474.73]

7.2 Willingness to pay = $1000

5

1577

Mean Difference (IV, Fixed, 95% CI)

329.53 [236.32, 422.74]

Figures and Tables -
Comparison 4. H. pylori test and treat vs. initial endoscopy
Comparison 5. H. pylori test and treat vs. acid suppression/placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Global assessment of dyspepsia (primary outcome) Show forest plot

4

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 H.pylori positive only

2

563

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.63, 0.91]

1.2 All patients randomised before testing

2

497

Risk Ratio (M‐H, Random, 95% CI)

0.86 [0.45, 1.64]

2 Endoscopies Show forest plot

1

294

Odds Ratio (M‐H, Fixed, 95% CI)

0.68 [0.31, 1.53]

Figures and Tables -
Comparison 5. H. pylori test and treat vs. acid suppression/placebo