Initial endoscopy or empirical therapy with or without testing for Helicobacter pylori for dyspepsia: A decision analysis

Background & Aims: Empirical therapy has been proposed for initial management of dyspepsia. The aim of this study was to evaluate initial endoscopy, empirical therapy, and testing for Helicobacter pylori in the management of patients with a new onset of dyspepsia, Methods: Decision analysis was used to compare the direct medical charges in the first year after the onset of dyspepsia for patients managed by initial endoscopy or empirical therapy, with or without initial testing for H. pylori. Results: Medical care charges were $2162.50 for initial endoscopy and $2122.60 for empirical therapy, a difference of 1.8%. For a 55-year-old adult, life expectancy was 23.49 years for initial endoscopy compared with 23.48 years for empirical therapy, Empirical therapy has lower charges than initial endoscopy when H-2-receptor antagonists are used to prevent recurrence of dyspepsia. initial noninvasive testing for H. pylori has lower charges than initial endoscopy if patients with dyspepsia with H. pylori receive antimicrobial therapy without endoscopy but would have higher charges if patients with H. pylori routinely have endoscopy. Conclusions: Surprisingly, the choice of optimal management strategy was a ''toss-up.'' Only modest savings may result from practice guidelines that recommend empirical therapy in the management of patients with dyspepsia.