The Predictive Value of History in Dyspepsia

Abstract

Symptomatic patients referred to an open-access upper gastrointestinal endoscopy completed a detailed, self-administered questionnaire aimed at assessing the predictive value of history in dyspepsia. Nine hundred and thirty patients were suitable for analysis. Of these, 29% were found to have organic dyspepsia. A substantial overlap of symptoms and demographic data was found among the various endoscopic diagnoses. Discriminating variables were identified by stepwise logistic regression analysis and included in predictive score models. Pain relieved by antacids, age above 40 years, previous peptic ulcer disease, male sex, symptoms provoked by berries, and night pain relieved by antacids and food were found to predict organic dyspepsia with a sensitivity and specificity of approximately 70%, when applied on the observed material. Similar probabilities were found for score models of peptic ulcer and esophagitis. In general, the low prevalence of organic diseases resulted in low positive and high negative predictive values. Accordingly, the main impact of the predictive models may be to reduce the number of negative endoscopies rather than to predict a precise diagnosis. Independent of disease category and age, 41% of the subjects expressed a fear of malignancy, emphasizing the value of reassurance from a negative endoscopy.

Diagnostic value of symptoms of oesophagogastric cancers in primary care: a systematic review and meta-analysis

“…When three outliers 12,14,16 were excluded, the summary sensitivity for pain reduced to 0.28 (95% CI = 0.18 to 0.41, data not shown); other metrics changed little.…”

“…[10][11][12][13][14][15][16]19,20 Sensitivity ranged between 0.00 and 0.78, and was <0.50 in two-thirds of studies; specificity was more precise ranging between 0.72 and 0.99 (Table 1). The LR+ ranged between 1.87 and 9.81, with the exception of one study (Table 1).…”

“…[10][11][12]14,16,20,21 Studies reporting epigastric or retrosternal pain are reported separately (Table 2). Sensitivity was low with the exception of two endoscopy clinic studies;…”

“…Six studies of over 53 000 patients reported any of these symptoms. 12,[14][15][16][20][21] The sensitivity was low, ranging from 0.00 to 0.38; specificity varied between 0.56 and 0.99 (Table 1). The LR+ ranged between 0.37 and 1.56 for endoscopy clinics, although it was 6.76 in one database study.…”

Utilidad de la ecografía en el diagnóstico de los pacientes con sospecha de neoplasias del tubo digestivo

“…Por el contrario, el VPP para la dispepsia orgánica es mucho más bajo (30%). Por el contrario, el elevado valor predictivo negativo (VPN) para la dispepsia orgánica (90-95%), comparado con el de la dispepsia funcional (40-45%), permite descartar con mayor seguridad la presencia de patología orgánica (7)(8)(9)(10)(11)(12)(13).…”