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. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42019132528.

中文翻译：

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未经调查的消化不良管理策略的有效性：系统评价和网络荟萃分析。

目的 确定未经调查的消化不良管理策略的有效性。设计系统评价和网络荟萃分析。数据来源 Medline、Embase、Embase Classic、Cochrane Central Register of Controlled Trials 和clinicaltrials.gov，从成立时间到 2019 年 9 月，没有语言限制。2001 年至 2019 年的会议记录。 选择研究的资格标准 评估成人参与者（年龄≥18 岁）未经调查的消化不良管理策略的有效性的随机对照试验。感兴趣的策略是快速内窥镜检查；检测幽门螺杆菌并对检测呈阳性的参与者进行内窥镜检查；对检测呈阳性的人进行幽门螺杆菌检测和根除治疗（“检测和治疗”）；经验性酸抑制；或基于症状的管理。试验报告了在最终随访（≥12 个月）时对症状状态的二分法评估。结果 该评价确定了 15 项符合条件的随机对照试验，包括 6162 名成人参与者。使用随机效应模型汇总数据。策略根据 P 分数进行排序，这是一种管理策略优于另一种的确定性的平均程度，是所有竞争策略的平均值。“测试和治疗”排名第一（剩余症状的相对风险为 0.89，95% 置信区间为 0.78 至 1.02，P 评分 0.79），提示内镜检查排名第二，但表现相似（0.90，0.80 至 1.02，P 评分 0.71）。然而，没有什么策略比“测试和治疗”更有效。被分配到“测试和治疗”的参与者 除了基于症状的管理（相对风险与基于症状的管理 0.60、0.30 至 1.18）之外，接受内镜检查的可能性显着降低（相对风险 v 提示内镜检查 0.23，95% 置信区间 0.17 至 0.31，P 评分 0.98）。与“测试和治疗”（相对风险v“测试和治疗”0.67，0.46至0.98）和经验性酸抑制（相对风险v经验性酸抑制0.58， 0.37 至 0.91）。在所有试验中，上消化道癌症发生率都较低。敏感性分析的结果保持稳定，直接和间接结果之间的不一致最小。个别试验的偏倚风险很高；由于实用的试验设计，盲法是不可能的。结论 “测试和治疗”排名第一，尽管它的表现与提示内窥镜检查相似，并且并不优于任何其他策略。除了基于症状的管理外，“测试和治疗”导致的内窥镜检查少于所有其他方法。然而，参与者表现出对及时内窥镜检查作为其症状管理策略的偏好。系统审查注册 PROSPERO 注册号 CRD42019132528。