[Is endoscopy necessary to initiate medical treatment in primary-level medical care patients with not investigated dyspepsia?].

INTRODUCTION

Approximately 2 to 5% of primary care consultations are patients with dyspepsia. One of the most controversial points among primary-care physicians and gastroenterologists is the diagnostic-therapeutic approach of the uninvestigated dyspeptic patient.

AIMS AND METHODS

Our aim was to investigate prevalence of organic disease and Helicobacter pylori (Hp) status in uninvestigated dyspeptic out-patients at a primary-care level. Two hundred two adult out-patients (130 F/72 M), > or = 18 and < 75 years, mean age 36 years (range 18-73 years), were recruited and sent for upper gastrointestinal endoscopy and gastric biopsies for CLO-test due to dyspeptic symptoms according to Rome II criteria. Patients were excluded if they had previously been investigated by any means, had a background of NSAIDs or corticoesteroids intake, irritable bowel syndrome (IBS) or any alarm sign or symptom. All endoscopic findings were reported to primary care physicians who decided on patient management.

RESULTS

A total of 86.14% (174/202 patients) showed no endoscopic lesions and only 13.86% (28/202) [95% CI = 9.1-18.6] showed evidence of non-malignant organic lesions. By age group, prevalence of organic diseases was 10.81% (16/148) [95% CI = 6.3-16.9] in patients < 45 years and 22.22% (12/54) [95% CI = 12.04-35.6] in patients > 45 years, OR = 0.424. [95% CI = 0.186-0.968].

CONCLUSIONS

Prevalence of upper gastrointestinal tract organic disease in dyspeptic out-patients selected according to Rome II criterion at a primary-care level is low, with no malignancies detected. These findings show that patients < 45 years of age with uninvestigated dyspepsia may empirically and safely receive symptom-guided antisecretory therapy.