Chronic dyspepsia: Who needs endoscopy?

doi:10.1016/S0016-5085(97)70153-7

Gastroenterology

Volume 112, Issue 4, April 1997, Pages 1376-1380

https://doi.org/10.1016/S0016-5085(97)70153-7 Get rights and content

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Changes in indications for upper gastrointestinal tract endoscopy and endoscopic findings during the last fifteen years in south-western greece
2008, American Journal of the Medical Sciences
During the past years, major advances in the management of upper gastrointestinal diseases have been achieved. The aim of this study was to determine if changes in indications for upper gastrointestinal endoscopy and endoscopic findings have occurred during the last 15 years in our area.
Indications for upper gastrointestinal tract endoscopy and endoscopy findings of patients who underwent upper endoscopy in years 1990, 1995, 2000, and 2005 in our department were compared.
Over the 15-year period, the number of diagnostic endoscopies performed in our department in years 1990, 1995, 2000, and 2005 increased (953, 1245, 2350, and 2528, respectively). Acute upper gastrointestinal bleeding had become less frequent (40%, 42.8%, 19.7%, 14.3%, P < 0.001), but dyspepsia (24.4%, 33.6%, 54.3%, 51.3%, P = 0.002) and reflux (1.8%, 1.3%, 5.1%, 10.8%, P = 0.005) more frequent indications for upper endoscopy. The endoscopic findings of duodenal ulcer (39.1%, 22.5%, 20.5%, 9.3%, P < 0.001), gastric ulcer (15.9%, 8.3%, 5.7%, 4.6%, P = 0.036) as well as erosive gastroduodenitis (35.6%, 22.2%, 15.3%, 4.7%, P < 0.001) decreased, whereas that of reflux esophagitis (3.1%, 10.1%, 12%, 16%, P = 0.034) increased. Moreover, the percentage of patients with negative endoscopy or minimal endoscopic findings (eg, nonerosive gastritis) increased (12.8%, 33.7%, 54.1%, 64.4%, P < 0.001).
In south-western Greece, dyspepsia and reflux as an indication for upper endoscopy have been increasing, whereas acute upper gastrointestinal bleeding has been decreasing. The finding of peptic ulcers at the upper gastrointestinal tract endoscopy has become significantly less frequent, while the percentage of patients with negative results of endoscopy seems to have been increasing rapidly.
How to explore and treat a dyspeptic patient?
2005, Gastroenterologie Clinique et Biologique
Upper gastrointestinal alarms: The 2-week rule
2005, Lancet
A survey of open-access endoscopy in primary health care centres: Outcome of gastric carcinoma patients diagnosed by general practitioners compared with hospital-referred endoscopy
2005, Digestive and Liver Disease
We examined open-access endoscopy service based on general practitioner endoscopists.
We compared the survival of the gastric carcinoma patients originally diagnosed in health care centres by general practitioner endoscopists and hospital outpatient clinic by specialists.
A total of 159 gastric carcinoma cases diagnosed during 1996–2000 were included in to the present study. Of them, 58% (N = 92) and 42% (N = 67) were detected by general practitioners and specialists, respectively. We observed no difference in the mean age of patients (71.3 years versus 71.4 years, p = 0.97) and stage of tumours [15% (N = 14) versus 21% localised tumours (N = 14, p = 0.30)] between cases diagnosed by general practitioners and specialists. The number of patients who underwent radical extirpation were 14% (N = 13) and 19% (N = 13, p = 0.38), respectively. After a minimum follow-up of 3.5 years, 29 patients (18%) were alive. The mean survival time of hospital-diagnosed carcinoma patients was longer (23.6 months versus 18.7 months, p = 0.23). Eight patients had undergone hospital-referred gastroscopy less than 3 years before cancer diagnosis. In multivariate analysis, radical extirpation of carcinoma (odds ratio 0.11, 95% confidence interval 0.04–0.28) predicted survival; whereas age (odds ratio 1.03 per year, 95% confidence interval 0.99–1.07 per year), female sex (odds ratio 1.785, 95% confidence interval 0.71–4.81) and the open-access endoscopy based on general practitioner endoscopists (odds ratio 1.48, 95% confidence interval 0.60–3.65) predicted neither survival nor carcinoma-related death.
No significant difference was detected in the outcome of gastric cancer patients diagnosed in primary care centres by general practitioner endoscopists and in hospital outpatient clinic by specialists.
Endoscopic evaluation of patients with dyspepsia: Results from the national endoscopic data repository
2004, Gastroenterology
Background & Aims: Endoscopy is commonly performed to evaluate symptoms of dyspepsia. The aim of this study was to characterize patients who receive endoscopy for dyspepsia and measure predictors of primary endoscopic outcomes, utilizing a large national endoscopic database. Methods: The Clinical Outcomes Research Initiative (CORI) receives endoscopy reports from a network of 74 sites in the United States. Sixty-one percent of reports come from private practice settings. Patients with reflux dyspepsia and nonreflux dyspepsia were identified from January 2000 to June 2002. Patients with dysphagia and known Barrett’s esophagus were excluded. Primary endoscopic outcomes included esophageal inflammation and stricture, gastric ulcer, duodenal ulcer, suspected Barrett’s esophagus (≥2cm), and suspected esophageal and gastric malignancy. The presence or absence of alarm symptoms (vomiting, weight loss, and evidence of GI blood loss) was determined. Adjusted relative risk (RR) for predicting serious outcomes was calculated in a multivariate model. Results: We received 117,497 endoscopic reports, representing 99,558 unique patients. Dyspepsia, with and without reflux symptoms, accounted for 43% of upper endoscopies. Among dyspeptic patients, 36.5% were younger than 50 years of age without alarm symptoms. Esophageal or gastric malignancy in patients with dyspepsia was associated with increasing age, male sex, Asian race, Native American race, and symptoms of weight loss and vomiting. Suspected Barrett’s esophagus (≥2cm) was associated with reflux symptoms, male sex, age, and white race. Ulcers were associated with evidence of bleeding, vomiting, male sex, black race, and Hispanic ethnicity. Conclusions These practice-based data reveal important practice behaviors and outcomes.
Chronic Acid-Related Disorders Are Common and Underinvestigated
2003, American Journal of Gastroenterology
Citation Excerpt :
Recent expert consensus-based guidelines recommend that patients >45 or 50 yr of age with symptoms of dyspepsia should be investigated (23–26). This recommendation is based on the increasing incidence of ominous pathologies for dyspepsia after about the age of 50 yr, when 1–2% of patients with dyspepsia are found to have gastric cancer (23–25, 33). Nevertheless, we found that 81% of patients ≥50 yr of age with dyspepsia had not undergone an endoscopy.
The aims of this study were as follows: to establish the prevalence of chronic acid-related disorders in a managed care population; to describe these patients; and to examine rates of adherence to current guidelines for investigation of dyspepsia and peptic ulcer disease.
The design was a population-based cohort study. The sample was drawn from 216,720 adult (aged >18 yr) members of a managed care organization that had an electronic medical record linked to administrative and pharmacy databases. We included adults with continuous enrollment from July, 1998, to January, 2000, who were dispensed histamine-2 blockers or proton-pump inhibitors, or both, for ≥1 yr. Dispensing data, sociodemographic and clinical information, comorbidities, and investigations were collected and analyzed.
The final cohort consisted of 5064 patients; 64% were aged ≥50 yr, 47% were male, and 11% were African American. The prevalence of chronic acid-related disorders was 2.3%. Gastroesophageal reflux disease (59%) was the most common condition, followed by dyspepsia (35% of cohort; 18% investigated by endoscopy). There were 917 dyspepsia patients ≥50 yr who had not been investigated by endoscopy (81% of dyspepsia patients in this age group). There were 97 patients with peptic ulcer disease who did not have a documented test for Helicobacter pylori (34% of patients with peptic ulcer disease).
Chronic acid-related disorders are common in primary care, and many patients use acid suppressing medications on a long-term basis. Nevertheless, according to current practice guidelines, our patients were underinvestigated. Future guidelines should specifically address the management of patients who use acid suppressing medications on a chronic basis.

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