Do young dyspeptics require endoscopy any more?

The main rationale for endoscoping young patients is to diagnose peptic ulcer disease and reassure those with a normal examination. Most peptic ulcers are known to be caused by Helicobacter pylori, leading to novel investigation strategies for young dyspeptic patients. In retrospective studies, screening patients under 45 years for H. pylori and only investigating those who were positive reduced the number of endoscopies without missing significant pathology. The European Helicobacter Pylori Study Group recommends that all dyspeptic patients 45 years of age or younger, without sinister symptoms, are given a non-invasive test for H. pylori. H. pylori-positive patients should receive acid pump inhibitor-based triple therapy, without further investigation. In Leeds, UK, open-access 13C-urea breath testing (UBT) is offered to dyspeptic patients under 40 years who are not taking non-steroidal anti-inflammatory drugs. H. pylori-negative patients are reassured and referred back to their general practitioner; positive patients receive omeprazole-based triple therapy for 1 week. Dyspepsia scores fell significantly following the UBT, reflected by a reduced number of visits to the general practitioner and a fall in H2-receptor antagonist prescriptions. Since introducing this service, there has been a 34% reduction in endoscopies in patients under 40 years in this unit.