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Stomach pain - evidence-based methods in the diagnosis and treatment of dyspepsia

Assessment objective
The project group has critically reviewed the scientific evidence of treatment for dyspepsia, and the relationship between bacterial infection involving Helicobacter pylori and dyspeptic disease as well as stomach cancer. Alternative strategies for management of patients with dyspeptic symptoms were assessed in a decision analysis. Estimates of the cost to society for dyspepsia were made.

Assessment strategy
Structured critical review of published original studies. Decision analysis. Cost analysis.

Primary data collection
Structured systematic literature review based on defined criteria in protocol. Reference lists included. Literature database searches, depending on the subject, but at the most from 1966-1998, and selected by hand until June 1999.

Studies included
RCT and CCT.

Review of publications
In the project group the literature was reviewed by at least two project members. External expert reviewers have assessed the manuscript. The SBU board and the SBU expert committee have made a final assessment before approval.

Results

Pharmaceuptical treatment


Stomach cancer prevention
General or targeted screening of H. pylori-infection is not motivated as an approach towards stomach cancer prevention.

Diagnostics of dyspepsia
Endoscopy gives the best information of investigation. There was an increase of almost 50 percent of endoscopy frequency in the 1990-ies and corresponds now to about 1,750 endocopies per 100,000 inhabitants.

Cost to society
The societal cost of dyspepsia is estimated between 3,700 and 4,400 Million SEK yearly. The estimated cost has remained about the same for several decades, however the structure of cost has changed. Cost of drugs has increased from 3 to 30 percent of total estimated societal cost.

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