An effective omeprazole-based dyspepsia treatment protocol, based on clinical history, symptoms, and Helicobacter pylori status, that provides rapid symptom relief in the majority of dyspeptic patients

There is a need for an effective (in terms of providing symptom relief and predictable healing of mucosal lesions) evidence-based treatment strategy for dyspepsia which offers the most appropriate utilisation of finite healthcare resources. This study evaluated a treatment strategy for dyspeptic patients (referred for endoscopy) based on clinical history, symptoms and H. pylori status. H. pylori positive patients (n = 188) received omeprazole 40 mg o.m., amoxycillin Ig b.d. and metronidazole 600 mg b.d. for one week followed by omeprazole 20 mg for three weeks. H. pylori negative (n = 176) patients received omeprazole 20 mg o.m. for four weeks. After four weeks, asymptomatic patients left the study whilst those still symptomatic received omeprazole 20 mg o.d. to 40 mg o.d. (based on clinical need) for a further four or eight weeks. Fifty-seven percent of patients from the overall heterogeneous study population achieved a stringent health target of symptom relief in two days, whilst 84% of patients' most troublesome (index) symptom improved after four weeks treatment. In conclusion, considered together with previous work, this study is supportive of a management approach where dyspeptic patients (excluding any with alarm symptoms or signs) are tested for H.pylori and if positive receive omeprazole-based H.pylori eradication treatment and if negative receive omeprazole alone. An omeprazole-based dyspepsia management strategy provides rapid symptom relief in the majority of dyspeptic patients and offers predictability of healing of mucosal lesions from symptom improvements in duodenal ulcer disease and reflux oesophagitis/gastroesophageal reflux disease, hence allowing clinical assessment to be used reliably in clinical decision making.