Web-Based Educational Intervention for Patients With Uninvestigated Dyspepsia Referred for Upper Gastrointestinal Tract Endoscopy

Abstract

IMPORTANCE Diagnostic yield of upper gastrointestinal (GI) tract endoscopy for uninvestigated dyspepsia is low, and its clinical implications are limited. There is an unmet need for better strategies to reduce the volume of upper GI tract endoscopic procedures for dyspepsia.OBJECTIVE To study the effectiveness of a web-based educational intervention as a tool to reduce upper GI tract endoscopy in uninvestigated dyspepsia. DESIGN, SETTING, AND PARTICIPANTSThis open-label, multicenter, randomized clinical trial enrolled participants between November 1, 2017, and March 31, 2019, with follow-up 52 weeks after randomization, at 4 teaching hospitals in the Netherlands. Participants included patients with uninvestigated dyspeptic symptoms who were referred for upper GI tract endoscopy by their general health care clinician without prior consultation of a gastroenterologist. A total of 119 patients, aged 18 to 69 years, were included. Patients were excluded if any of the following red flag symptoms were present: (indirect) signs of upper GI tract hemorrhage (hematemesis, melena, hematochezia, or anemia), unintentional weight loss of 5% or higher of normal body weight during a period of 6 to 12 months, persistent vomiting, dysphagia, or jaundice.INTERVENTIONS Patients were randomly assigned (1:1) to education (intervention) or upper GI tract endoscopy (control). Education consisted of a self-managed web-based educational intervention, containing information on gastric function, dyspepsia, and upper GI tract endoscopy. MAIN OUTCOMES AND MEASURESDifference in the proportion of upper GI tract endoscopy procedures between those who received access to the web-based educational intervention and those who did not at 12 weeks and 52 weeks after randomization, analyzed in the intention-to-treat population. Secondary outcomes included quality of life (Nepean Dyspepsia Index) and symptom severity (Patient Assessment of Gastrointestinal Disorders Symptom Severity Index) measured at baseline and 12 weeks. RESULTSOf 119 patients included (median age, 48 years [interquartile range, 37-56 years]; 48 men [40%]), 62 were randomized to web-based education (intervention) and 57 to upper GI tract endoscopy (control). Significantly fewer patients compared with controls underwent upper GI tract endoscopy after using the web-based educational intervention: 24 (39%) vs 47 (82%) (relative risk, 0.46; 95% CI, 0.33-0.64; P < .001). Symptom severity and quality of life improved equivalently in both groups. One additional patient in the intervention group required upper GI tract endoscopy during follow-up.CONCLUSIONS AND RELEVANCE Findings of this study indicate that web-based patient education is an effective tool to decrease the need for upper GI tract endoscopy in uninvestigated dyspepsia.

British Society of Gastroenterology guidelines on the management of functional dyspepsia

“…http://gut.bmj.com/ Gut: first published as 10.1136/gutjnl-2022-327737 on 7 July 2022. Downloaded from and was associated with similar improvements in symptoms and quality of life, compared with prompt endoscopy 127.…”

Effect of the COVID-19 pandemic on procedure volumes in gastroenterology in the Netherlands

“…8,9 Nevertheless, some of these procedures could also have been superfluous and might not have needed to be performed. 10 In conclusion, we observed profound reductions in gastro enterological procedure volumes during the first wave of the COVID-19 pandemic. Procedure volumes returned to or increased above reference levels during subsequent phases of the pandemic, which is a testament to the resilience and creativity of gastroenterology departments across the nation.…”

When I use a word . . . . Too much healthcare—overdetection

“…In a review of strategies used to reduce the use of upper GI endoscopy for dyspepsia, one of the most common inappropriate indications, the authors identified strategies for each of four targets: development and implementation of guidelines, clinical assessment using algorithm-based referral, testing for Helicobacter pylori , and offering treatment with a proton pump inhibitor or a histamine H 2 receptor antagonist 16. The results of a subsequent clinical trial suggested that at least web-based patient education is effective in reducing the need for upper GI endoscopy in uninvestigated dyspepsia 17…”