In this thesis various studies on the management of patients presenting with dyspepsia in primary care are described. Of all patients presenting with dyspepsia, only a minority has organic disease. Roughly 25% of the dyspeptic patients presenting in primary care is referred for endoscopy. At endoscopy, relevant organic disease is found in 30-45% of the patients (5-15% peptic ulcer disease and 25-30% gastro-oesophageal disease). Helicobacter pylori (H pylori) infection is accepted as the most common cause of gastritis, and is aetiologically involved in gastric ulcer, duodenal ulcer and primary gastric B-cell lymphoma. For this reason, the role of H pylori diagnosis and treatment in the management of peptic ulcer disease (PUD) has been a topic of interest in research. Ideally, patients suspected of PUD should be tested for H pylori infection without undergoing endoscopy. H pylori eradication is effective PUD treatment and prevents relapses. Therefore, the diagnostic value of non-invasive H pylori tests (i.e. tests not requiring an endoscopy) in PUD diagnosis should be evaluated. In addition, the additional diagnostic value of H pylori tests in patients at risk for PUD have to be determined. Finally, a guideline based on the established diagnostic value of H pylori testing in dyspeptic patients in primary care needs to be developed and introduced effectively in medical practice.
The research questions answered in this thesis are:
* To what extent is H pylori diagnosis and treatment currently incorporated in dyspepsia management in primary care in the Netherlands?
* What is the value of H pylori testing in addition to history taking in diagnosing peptic ulcer disease in primary care?
* What is the optimal non-invasive H pylori test for diagnosis in primary care?
* What is the diagnostic performance of a new immunoassay for the detection of H pylori infection in primary care?
* Is compliance with a new dyspepsia guideline increased after introduction by an educational or financial stimulus for GPs