Brennan M.R. Spiegel, Nimish B. Vakil, Joshua J. Ofman

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Dyspepsia management in primary care: A decision analysis of competing strategies Brennan M.R. Spiegel, Nimish B. Vakil, Joshua J. Ofman Gastroenterology Volume 122, Issue 5, Pages 1270-1285 (May 2002) DOI: 10.1053/gast.2002.33019 Copyright © 2002 American Gastroenterological Association Terms and Conditions

Fig. 1 Truncated diagnostic flowchart of 4 empiric strategies for the management of simple uninvestigated dyspepsia. Square nodes denote decision points where the clinician may choose between alternative paths. Patients progress through each strategy only if persistently symptomatic. Two strategies (T&T→EGD and T&T→PPI→EGD) begin with the test and treat approach for H. pylori, and 2 others (PPI→EGD and PPI→T&T→EGD) begin with a 6-week trial of PPI. All strategies progress to upper endoscopy for patients with refractory symptoms. The strategy supported by current guidelines is marked in bold lines. See text for details on the individual strategies. Gastroenterology 2002 122, 1270-1285DOI: (10.1053/gast.2002.33019) Copyright © 2002 American Gastroenterological Association Terms and Conditions

Fig. 2 Two-way sensitivity analysis comparing the cost of upper endoscopy with the probability of initial symptom improvement of NUD with H. pylori eradication. The T&T→PPI→EGD strategy remains the most cost-effective as long as the cost of endoscopy remains above $250 and the probability of NUD symptom improvement with H. pylori eradication remains above 36%. Gastroenterology 2002 122, 1270-1285DOI: (10.1053/gast.2002.33019) Copyright © 2002 American Gastroenterological Association Terms and Conditions

Fig. 3 Two-way sensitivity analysis comparing the cost of anti–H. pylori therapy with the probability of underlying erosive esophagitis. The T&T→PPI→EGD strategy remains the most cost-effective as long as the cost of antibiotic therapy remains below $365 and the probability of esophagitis remains below 55%. Gastroenterology 2002 122, 1270-1285DOI: (10.1053/gast.2002.33019) Copyright © 2002 American Gastroenterological Association Terms and Conditions