Lieberman David, Fennerty M Brian, Morris Cynthia D, Holub Jennifer, Eisen Glenn, Sonnenberg Amnon
Division of Gastroenterology, Oregon Health and Science University, Portland, Oregon 97239, USA.
Gastroenterology. 2004 Oct;127(4):1067-75. doi: 10.1053/j.gastro.2004.07.060.
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.
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 (> or =2 cm), 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.
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 (> or =2 cm) 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.
These practice-based data reveal important practice behaviors and outcomes.
内镜检查常用于评估消化不良症状。本研究旨在利用一个大型全国性内镜数据库，对因消化不良接受内镜检查的患者进行特征描述，并测量主要内镜检查结果的预测因素。
临床结果研究倡议组织（CORI）从美国74个地点的网络接收内镜检查报告。61%的报告来自私人诊所。2000年1月至2002年6月期间识别出反流性消化不良和非反流性消化不良患者。排除吞咽困难和已知巴雷特食管的患者。主要内镜检查结果包括食管炎和狭窄、胃溃疡、十二指肠溃疡、疑似巴雷特食管（≥2 cm）以及疑似食管和胃恶性肿瘤。确定是否存在警示症状（呕吐、体重减轻和胃肠道失血证据）。在多变量模型中计算预测严重结果的校正相对风险（RR）。
我们收到了117497份内镜检查报告，代表99558名不同患者。有或无反流症状的消化不良占上消化道内镜检查的43%。在消化不良患者中，36.5%年龄小于50岁且无警示症状。消化不良患者的食管或胃恶性肿瘤与年龄增加、男性、亚洲种族、美洲原住民种族以及体重减轻和呕吐症状相关。疑似巴雷特食管（≥2 cm）与反流症状、男性、年龄和白人种族相关。溃疡与出血证据、呕吐、男性、黑人种族和西班牙裔相关。
这些基于实践的数据揭示了重要的实践行为和结果。
