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Optimal Sequence of Dyspepsia Treatments Proposed
Starting patients with dyspepsia on antacids and then progressing stepwise to more expensive therapies seems more cost effective than reversing the sequence, according to a Lancet study, but a commentator disagrees.
Researchers randomized some 650 patients with new-onset dyspepsia to one of two treatment sequences: the "step up" arm started with antacids, then H2-receptor antagonists, then proton-pump inhibitors; the "step down" arm used the same treatments but in reverse order. Each step lasted 4 weeks, and patients proceeded to the next step only if symptoms persisted or relapsed.
By 6 months after entry, both groups had achieved equal measures (roughly 70%) of adequate symptom relief , but average costs were lower in the step-up group.
A commentator, citing flaws in the study's design (e.g., the paucity of information gathered that would allow estimates of true effect size) says the work is "not likely to alter current management."
LINK(S):
Lancet article (Free abstract; full text requires subscription)
Lancet comment (Subscription required)
Published in Physician's First Watch January 16, 2009
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