Moayyedi Paul, Talley Nicholas J, Fennerty M Brian, Vakil Nimish
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
JAMA. 2006 Apr 5;295(13):1566-76. doi: 10.1001/jama.295.13.1566.
Upper gastrointestinal symptoms occur in 40% of the population. An accurate diagnosis would help rationalize investigation and treatment.
To systematically review the literature of the accuracy of primary care physicians, gastroenterologists, or computer models in diagnosing organic dyspepsia.
A search of Cochrane Controlled Trials Register (December 2003), MEDLINE (1966-December 2003), EMBASE (1988-December 2003), and CINAHL (1982-December 2003) for studies that reported on cohorts of patients attending for endoscopy that had symptoms, clinical opinion, or both recorded before investigation.
Studies that prospectively compared the diagnosis reached by a clinician, computer model, or both with results of upper gastrointestinal endoscopy in adult patients with upper gastrointestinal symptoms.
Two authors independently assessed studies (n = 79) for eligibility and abstracted data for estimating likelihood ratios (LRs) of clinical opinion, computer models, or both in diagnosing an organic cause for dyspepsia.
Fifteen studies were identified that evaluated 11 366 patients, with 4817 patients (42%) classified as having organic dyspepsia. The computer models performed similarly to the clinician; therefore, the 2 approaches were combined. The diagnosis reached by the clinician or computer model suggesting organic dyspepsia had an LR of 1.6 (95% confidence interval [CI], 1.4-1.8), and a negative result decreased the likelihood of organic dyspepsia (LR, 0.46; 95% CI, 0.38-0.55). A diagnosis of peptic ulcer disease performed similarly with an LR of 2.2 (95% CI, 1.9-2.6), but an evaluation that suggested the absence of peptic ulcer disease had an LR of 0.45 (95% CI, 0.38-0.53). A clinical history suggesting esophagitis had an LR of 2.4 (95% CI, 1.9-3.0) vs a negative history that had an LR of 0.50 (95% CI, 0.42-0.60).
Neither clinical impression nor computer models that incorporated patient demographics, risk factors, history items, and symptoms adequately distinguished between organic and functional disease in patients referred for endoscopic evaluation of dyspepsia.
40%的人群存在上消化道症状。准确的诊断有助于使检查和治疗更加合理。
系统回顾关于初级保健医生、胃肠病学家或计算机模型诊断器质性消化不良准确性的文献。
检索考克兰对照试验注册库（2003年12月）、医学索引数据库（1966年至2003年12月）、荷兰医学文摘数据库（1988年至2003年12月）和护理学与健康领域数据库（1982年至2003年12月），查找报告了有症状、临床意见或二者均在检查前记录的接受内镜检查患者队列的研究。
前瞻性比较临床医生、计算机模型或二者得出的诊断与有上消化道症状成年患者上消化道内镜检查结果的研究。
两位作者独立评估研究（n = 79）的合格性，并提取数据以估计临床意见、计算机模型或二者诊断消化不良器质性病因的似然比（LRs）。
确定了15项研究，共评估11366例患者，其中4817例患者（42%）被分类为患有器质性消化不良。计算机模型的表现与临床医生相似；因此，将这两种方法合并。临床医生或计算机模型得出的提示器质性消化不良的诊断的似然比为1.6（95%置信区间[CI]，1.4 - 1.8），阴性结果降低了器质性消化不良的可能性（似然比，0.46；95% CI，0.38 - 0.55）。消化性溃疡病的诊断表现相似，似然比为2.2（95% CI，1.9 - 2.6），但提示无消化性溃疡病的评估的似然比为0.45（95% CI，0.38 - 0.53）。提示食管炎的临床病史的似然比为2.4（95% CI，1.9 - 3.0），而阴性病史的似然比为0.50（95% CI，0.42 - 0.60）。
对于因消化不良接受内镜评估的患者，临床印象和纳入患者人口统计学、危险因素、病史项目及症状的计算机模型均不能充分区分器质性疾病和功能性疾病。
