Dyspepsi och reflux. Systematisk litteraturöversikt från SBU

SBU performed a systematic review concerning dyspepsia and gastroesophageal reflux disease (GERD). The review included the perspective of managing patients in primary care. Dyspepsia is a common condition but varies from one geographic area to another. Despite presenting symptoms of dyspepsia, a majority of patients may not have an ulcer diagnosis (non-ulcer dyspepsia [NUD]). For undiagnosed GERD and diagnosed erosive GERD, proton pump inhibitors (PPIs) provide better relief of symptoms than histamine-H2 antagonists. When it comes to long-term treatment of erosive GERD, continued use of PPIs leads to better patient outcomes than PPIs on demand. PPIs are safe for long-term treatment and indicated even for young patients. Adverse effects are rare. Eradication of H. pylori reduces the risk of duodenal ulcer and ventricular ulcer. Eradication of H. pylori is more effective than acid suppression alone for preventing a new episode of bleeding. Eradication of H. pylori for patients with NUD may provide minor relief of symptoms. But because the majority of patients with NUD are not infected with H. pylori, the treatment will have no effect on them. PPIs may provide some relief of NUD symptoms, but studies that analyzed the effectiveness of PPIs for NUD symptoms also included patients with GERD. As a result, it is difficult to draw any conclusions in that regard. Patients with Barrett's esophagus are at increased risk of developing adenocarcinoma of the esophagus. However, published studies offer no evidence that screening or surveillance will detect cancer at an early stage. There is a need for independent dyspepsia research, including health economic studies.