"Alarm symptoms" in dyspepsia. How does the general practitioner investigate?

OBJECTIVE

Alarm symptoms are present in 10% of patients consulting a general practitioner (GP) because of dyspepsia. The options for the GP are: perform "own" investigation, refer to a specialist or secondary care, or maintain watchful waiting.

DESIGN

Postal questionnaire to GPs obtaining information from the records of patients who had consulted earlier owing to dyspepsia and reported one or more alarm symptoms at the consultation.

SETTING

92 general practices throughout Denmark.

SUBJECTS

In 7240 consecutive consultations in 1991-1992 a total of 749 patients reported 881 alarm symptoms. Follow-up data 3 years later were obtained from 81%.

MAIN OUTCOME MEASURES

The management of alarm symptoms by GPs: "own" investigation, referral to specialist, or expectance; procedures used in "own" investigations, patient characteristics related to such decisions, and gastrointestinal diseases diagnosed by this management.

RESULTS

67% of the patients with alarm symptoms were investigated promptly (8% by referral to specialists) and 33% were left uninvestigated, with great variations between alarm symptoms. The single most preferred GP investigation was endoscopy. A gastrointestinal diagnosis was obtained in 35% of the patients; 3% of these were malignancies while 9% were peptic ulcers.

CONCLUSION

The decision on whether and how to investigate alarm symptoms is complex and relates to specific symptom, type of dyspepsia, age, gender and dwelling of the patient.