The prevalence of clinically significant endoscopic findings in primary care patients with uninvestigated dyspepsia: the Canadian Adult Dyspepsia Empiric Treatment – Prompt Endoscopy (CADET–PE) study

Abstract

Summary Background: Uninvestigated dyspepsia is common in family practice. The prevalence of clinically significant upper gastrointestinal findings (CSFs) in adult uninvestigated dyspepsia patients, and their predictability based on history, is unknown. Methods: Prompt endoscopy was performed within 10 days of referral, in 1040 adult patients presenting with uninvestigated dyspepsia at 49 Canadian family practitioner centres. Subsequent management strategies during a 6‐month follow‐up period were determined by the individual family practitioners. Results: CSFs were identified in 58% (603/1040) of patients. Erosive oesophagitis was most common (43%; N = 451); peptic ulcer was uncommon (5.3%; N = 55). Alarm symptoms were uncommon (2.8%; N = 29). Most patients had at least three dyspepsia symptoms, more than 80% had at least six, and approximately half had eight or more. Based on the dominant symptom, 463 (45%) patients had ulcer‐like, 393 (38%) had reflux‐like and 184 (18%) had dysmotility‐like dyspepsia. The patients' dominant symptom was not predictive of endoscopic findings. Oesophagitis was more common in those with dominant reflux‐like symptoms and was the most common finding in all subgroups. The prevalence of gastroduodenal findings was similar in all symptom subgroups. Helicobacter pylori (H. pylori) infection (30%; 301/1013) was associated with gastroduodenal findings. Conclusions: Dyspepsia subclassifications, based on dominant symptom, are of limited value in predicting the presence and nature of CSFs. Oesophagitis was by far the most common diagnosis (43% of patients). CSFs were common in uninvestigated dyspepsia patients and their nature suggests patients could be initially treated effectively, without endoscopy, using empirical acid suppressive therapy.

Symptom overlap in patients with upper gastrointestinal complaints in the Canadian confirmatory acid suppression test (CAST) study: further psychometric validation of the reflux disease questionnaire

“…3,[31][32][33][34] In population-based studies, up to two-thirds of subjects with GERD also have symptoms of dyspepsia 31,35 , while approximately half of subjects with dyspepsia also have HB and ⁄ or regurgitation. 31,33 In addition, many patients have difficulty distinguishing symptoms relating to HB from those relating to dyspepsia.…”

“…[1][2][3] Dyspepsia and gastro-oesophageal reflux disease (GERD) are the major diagnoses in patients who consult with upper GI symptoms. [4][5][6][7] The diagnosis and management of patients with upper GI symptoms are primarily symptom driven.…”

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

“…10,11,13,15,16,19,20 It was defined as a recorded haemoglobin of <11 g/dl over the previous year in two studies [10][11] and grouped with gastrointestinal bleeding in another. 15 Sensitivity of anaemia for oesophagogastric cancer was low, with high specificity; LR+ ranged between 1.32 and 8.33, excluding one study 20 where few patients presented with anaemia, cancer was rare, and most patients were aged <50 years (Table 1).…”

Role of Ultrasound in the Evaluation of Acute Pelvic Pain in Nonpregnant Reproductive Age Patients

“…Given such a vast differential diagnosis, the key investigative tool for acute lower abdominal and pelvic pain is the ultrasound. [8][9][10][11][12][13][14][15] In the emergency department setting ultrasound is the best initial imaging modality for evaluation of pelvic pathology due to its low cost, easy accessibility, widespread availability and lack of ionizing radiation. 16 Additional investigations include the following: • CBC: To detect an elevated leukocytosis (nonspecific).…”