XXXX management in primary care.

@entity1 @entity1534 @entity2210
BACKGROUND: @entity2210 is common in western society. Prompt endoscopy is imperative in all @entity1 with sinister symptoms or if symptoms first appear after the age of 50-55 years, but the optimal management of younger @entity1 with @entity2210 is still open to debate. METHODS: The literature on the management of @entity2210 is reviewed and a personal view is presented. RESULTS: Strategies based on non-invasive detection of @entity1534 are probably the most cost-effective. Currently ( @entity1534 prevalence 30%-40%), a 'test and treat' approach using a non-invasive test to detect @entity1534 is likely to be the most efficient first step. If the @entity1 is @entity1534 -negative or if symptoms persist after successful @entity1534 eradication, empirical treatment with an anti-secretory drug is justified. Endoscopy is reserved for those @entity1 in whom this approach fails. If the prevalence of @entity1534 decreases, the positive predictive value of any non-invasive @entity1534 test will become too low. A 'test and scope' approach in which a positive test can be confirmed by two or more biopsy-based tests is then more appropriate. At a very low prevalence of @entity1534 in the dyspeptic population, non-invasive testing for @entity1534 loses its significance and empirical treatment with an antisecretory drug becomes a rational first step. CONCLUSIONS: The optimal approach to management of @entity2210 is dependent on the prevalence of @entity1534 among the dyspeptic population. At the current prevalence rate, 'test and treat', followed by acid suppressive treatment in the case of persisting symptoms, is the most appropriate strategy.
