Helicobacter pylori "test-and-treat'' strategy is not suitable for the management of patients with uninvestigated dyspepsia in Shanghai

Objective. The safety of Helicobacter pylori "test-and-treat'' and "test-and-endoscopy'' strategies for the management of young patients with uninvestigated dyspepsia has not been evaluated in Shanghai. Material and methods. A total of 14,101 consecutive patients with dyspepsia receiving endoscopy in our hospital from October 2002 to December 2003 were retrospectively studied. The detection rates of esophageal or gastroduodenal malignancies and alarm symptoms were investigated, and H. pylori status was assessed. Results. A total of 202 (1.4%) gastrointestinal (GI) malignancies were found, including 162 cases (1.15%) of gastric cancer, 4 of gastric lymphoma, 35 (0.25%) of esophageal cancer and 1 case of duodenal cancer. Among those patients with GI malignancies, 99 (49.0%) were infected with H. pylori and 108 (53.5%) presented with alarm symptoms. Eighteen patients (0.46%, 18/3952) under 45 years of age were diagnosed as having gastric cancer. Of these patients, 5 (27.8%) presented with alarm symptoms and 13 (72.2%) were infected with H. pylori. If the H. pylori "test-and-treat'' strategy were used in dyspeptic patients under the age of 45 years without alarm symptoms in the Shanghai region, then 13 cases ( 72.2%) of gastric cancer would be missed. If the H. pylori "test-and-endoscopy'' strategy were applied, then 3 cases (16.7%) of gastric cancer would be missed. Conclusions. H. pylori "test-and-treat'' and "test-and-endoscopy'' strategies are both not suitable for the management of patients with uninvestigated dyspepsia in Shanghai. For most Shanghai dyspeptic patients, prompt endoscopy should be recommended as the first-line initial management option.