Conry B G, McLean A M, Farthing M J
Department of Radiology, St Bartholomew's Hospital, London.
BMJ. 1989 Dec 9;299(6713):1443-5. doi: 10.1136/bmj.299.6713.1443.
To assess the efficacy of barium meal examinations in managing patients with dyspepsia in general practice.
Prospective study by questionnaires completed by general practitioners before and within three to six months after the barium meal examination. Information was requested about the patients' symptoms, current treatment, reason for requesting the examination, and the working diagnosis, including degree of certainty and, after the examination, about any change in diagnosis, diagnostic confidence, or management and to determine whether the examination was judged to be helpful or not.
Inner city health district.
133 Patients with dyspepsia referred by general practitioners for outpatient barium meal examination, 31 of whom failed to attend for the examination, or refused it on arrival, or did not have fully completed questionnaires. Two patients were not available for follow up.
Prevalence of radiological abnormalities and the influence of the examination result on management, particularly changes in drug treatment.
Fully completed pairs of questionnaires were available for 100 patients, 58 of whom were aged below 50. Most of the barium meal reports (64) were to confirm the clinical diagnosis; only 22 were to exclude serious disease. Ninety nine patients were already receiving treatment, with 39 taking an H2 receptor antagonist. Fifty eight barium meal examinations showed abnormalities (31 major abnormalities); there were no cancers and in only 18 patients was the working diagnosis changed as a result of the findings. Although the barium meal result increased management confidence (63 patients) and allayed patients' anxiety (46), changes in management attributed directly to the examination occurred in only 22 patients. Management changes were minor, usually comprising interchange of antacids and H2 receptor antagonists.
Young patients (aged below 50) with dyspepsia are still being overinvestigated. Although barium meal examination improves diagnostic confidence and allays patients' anxiety, fully utilising communication skills at the initial consultation might allay anxiety more economically.
评估在全科医疗中钡餐检查对消化不良患者的疗效。
通过全科医生在钡餐检查前及检查后三至六个月内填写问卷进行前瞻性研究。问卷内容包括患者症状、当前治疗情况、检查申请原因、初步诊断（包括确定程度），以及检查后诊断、诊断信心、治疗管理方面的任何变化，并确定该检查是否被认为有帮助。
市中心城区卫生区。
133例由全科医生转诊进行门诊钡餐检查的消化不良患者，其中31例未参加检查、到达后拒绝检查或问卷未完全填写。2例患者无法进行随访。
放射学异常的发生率以及检查结果对治疗管理的影响，特别是药物治疗的变化。
100例患者有完整的配对问卷，其中58例年龄在50岁以下。大多数钡餐检查报告（64份）用于确认临床诊断；仅22份用于排除严重疾病。99例患者已在接受治疗，其中39例服用H2受体拮抗剂。58例钡餐检查显示异常（31例为主要异常）；未发现癌症，仅18例患者的初步诊断因检查结果而改变。虽然钡餐检查结果提高了治疗管理信心（63例患者）并减轻了患者焦虑（46例），但直接因检查导致的治疗管理变化仅发生在22例患者中。治疗管理变化较小，通常是抗酸剂和H2受体拮抗剂的互换。
年轻的（50岁以下）消化不良患者仍被过度检查。虽然钡餐检查提高了诊断信心并减轻了患者焦虑，但在初次会诊时充分运用沟通技巧可能更经济地减轻焦虑。
