2019年12月11日，英国圣詹姆斯大学医院Alexander C Ford课题组在《英国医学杂志》发表论文，宣布他们的研究系统分析了消化不良管理策略的有效性。

研究组对Medline、Embase、clinicaltrials.gov等大型数据库中自成立至2019年9月的相关文献进行检索，筛选出成人消化不良管理策略有效性的随机试验。

最终共确定了15个合格的随机对照试验，包括6162名成人参与者。采用随机效应模型对数据进行汇总。采用P得分对策略进行排序，即一个策略优于另一个策略的平均确定程度。

这些管理策略包括：快速内镜检查；检测幽门螺杆菌，阳性参与者行内镜检查；幽门螺杆菌阳性参与者进行根除治疗（检测和治疗） ；经验性抑酸；基于症状的管理。

“检测和治疗”排在第一位，症状残留的相对风险为0.89，P评分为0.79；快速内镜排第二位，相对风险为0.90，P评分为0.71，但与第一位相差不大。然而，“检测和治疗”策略的有效性最差。

除症状管理外，接受“检测和治疗”的参与者较少接受内镜检查。快速内镜检查的患者满意程度较高。所有试验中上消化道癌的发生率都很低。这些结果在敏感性分析中仍保持一致。个体试验的偏倚风险较高。

总之，“检测和治疗”排在第一位，尽管它的表现与快速内镜检查相差不大，但并不优于其他策略。

附：英文原文

Title: Effectiveness of management strategies for uninvestigated dyspepsia: systematic review and network meta-analysis

Author: Leonardo H Eusebi, Christopher J Black, Colin W Howden, Alexander C Ford

Issue&Volume: 2019/12/11

Abstract: 

Objective To determine the effectiveness of management strategies for uninvestigated dyspepsia.

Design Systematic review and network meta-analysis.

Data sources Medline, Embase, Embase Classic, the Cochrane Central Register of Controlled Trials, and clinicaltrials.gov from inception to September 2019, with no language restrictions. Conference proceedings between 2001 and 2019.

Eligibility criteria for selecting studies Randomised controlled trials that assessed the effectiveness of management strategies for uninvestigated dyspepsia in adult participants (age ≥18 years). Strategies of interest were prompt endoscopy; test for Helicobacter pylori and perform endoscopy in participants who test positive; test for H pylori and eradication treatment in those who test positive (“test and treat”); empirical acid suppression; or symptom based management. Trials reported dichotomous assessment of symptom status at final follow-up (≥12 months).

Results The review identified 15 eligible randomised controlled trials that comprised 6162 adult participants. Data were pooled using a random effects model. Strategies were ranked according to P score, which is the mean extent of certainty that one management strategy is better than another, averaged over all competing strategies. “Test and treat” ranked first (relative risk of remaining symptomatic 0.89, 95% confidence interval 0.78 to 1.02, P score 0.79) and prompt endoscopy ranked second, but performed similarly (0.90, 0.80 to 1.02, P score 0.71). However, no strategy was significantly less effective than “test and treat.” Participants assigned to “test and treat” were significantly less likely to receive endoscopy (relative risk v prompt endoscopy 0.23, 95% confidence interval 0.17 to 0.31, P score 0.98) than all other strategies, except symptom based management (relative risk v symptom based management 0.60, 0.30 to 1.18). Dissatisfaction with management was significantly lower with prompt endoscopy (P score 0.95) than with “test and treat” (relative risk v “test and treat” 0.67, 0.46 to 0.98), and empirical acid suppression (relative risk v empirical acid suppression 0.58, 0.37 to 0.91). Upper gastrointestinal cancer rates were low in all trials. Results remained stable in sensitivity analyses, with minimal inconsistencies between direct and indirect results. Risk of bias of individual trials was high; blinding was not possible because of the pragmatic trial design.

Conclusions “Test and treat” was ranked first, although it performed similarly to prompt endoscopy and was not superior to any of the other strategies. “Test and treat” led to fewer endoscopies than all other approaches, except symptom based management. However, participants showed a preference for prompt endoscopy as a management strategy for their symptoms.

DOI: 10.1136/bmj.l6483

Source: https://www.bmj.com/content/367/bmj.l6483