A prospective study of the management of the young Helicobacter pylori negative dyspeptic patient--can gastroscopies be saved in clinical practice?

Eur J Gastroenterol Hepatol. 1998 Nov;10(11):953-6. doi: 10.1097/00042737-199811000-00009.


Background: Helicobacter pylori status has been suggested as a means of selecting young dyspeptic patients for gastroscopy as patients who are H. pylori negative and do not exhibit alarm symptoms or ingest non-steroidal anti-inflammatory medication have a low risk of serious organic disease.

Aim: To determine if young patients with ulcer-like dyspepsia and found to be H. pylori negative on non-invasive testing could be reassured by this knowledge and not proceed to gastroscopy.

Patients: One hundred and sixty-one consecutive attendees aged 45 years or less with a presenting complaint of epigastric pain or discomfort were prospectively recruited from open access gastroscopy referrals and gastroenterology clinics.

Methods: Patients who were H. pylori negative on 13-carbon urea breath test were reassured of the likelihood of a normal gastroscopy, given lifestyle advice and also advised to take symptomatic therapy as required. Patients were reviewed at 6 weeks, 3 months and 6 months when symptoms and quality of life were reassessed. Patients proceeded to gastroscopy if at any review their dyspepsia score stayed the same or worsened.

Results: Fifty-five H. pylori negative patients were recruited (30 male, mean age 31 years), two patients did not attend subsequent review. Thirty-two (58%) came to gastroscopy. Endoscopic diagnoses included 25 which were normal, three with gastro-oesophageal reflux disease, three with peptic ulcer disease and one with gastric erosions. Dyspepsia and quality of life scores showed significant improvement over 6 months.

Conclusions: This management strategy resulted in a 42% reduction in gastroscopies in H. pylori negative patients. Whilst the majority of patients endoscoped had normal findings, seven patients (22%) had pathology. Overall there were significant improvements in dyspepsia and quality of life at 6 month follow-up.

MeSH terms

  • Adult
  • Dyspepsia / microbiology
  • Dyspepsia / therapy*
  • Female
  • Gastroscopy / statistics & numerical data*
  • Helicobacter Infections / diagnosis*
  • Helicobacter pylori / isolation & purification
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Quality of Life