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Endoscopic Findings in Patients with Dyspepsia

Summary and Comment |
May 7, 2010

Endoscopic Findings in Patients with Dyspepsia

  1. David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

In a community-based study, only one fourth of patients with dyspepsia had endoscopic findings.

  1. David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

Prior studies have shown an association between dyspepsia and endoscopic findings in patients referred for endoscopy. To find out whether this association applies to the general population, investigators conducted a community-based trial involving 1033 participants — with or without dyspeptic symptoms — from two Italian villages. All participants completed gastrointestinal-symptom questionnaires and underwent urea breath testing for Helicobacter pylori infection and endoscopic examinations with biopsies for rapid urease testing and histological evaluation. The main results were as follows:

  • 53.4% of participants were asymptomatic, 27.6% reported dyspepsia with or without prominent reflux symptoms, 10.5% reported prominent reflux symptoms without dyspepsia, and 7.5% reported alarm symptoms (dysphagia or odynophagia).

  • Endoscopic findings were observed in 23.2% of participants; findings were observed in 27.4% of participants with dyspeptic symptoms and in 17.6% of those with no symptoms.

  • The most prevalent endoscopic findings — esophagitis and peptic ulcers — were observed in 11.8% and 5.9% of patients, respectively; these findings were more common in patients with dyspeptic symptoms than in those with reflux, alarm, or no symptoms.

  • In patients with dyspepsia, esophagitis was more common in those with reflux symptoms than in those without (16.8% vs. 8.1%), but prevalence of peptic ulcers was similar in those with and without reflux symptoms (9.4% and 8.8%, respectively).

  • 93.4% of patients with peptic ulcers also had H. pylori infection.

  • The prevalence of gastric cancer was highest in participants who reported alarm symptoms (9.1%) compared with those who reported dyspepsia, reflux, or no symptoms, but about one third of all cancers occurred in the absence of alarm symptoms.

The authors concluded that nearly three fourths of patients with dyspepsia do not have endoscopic lesions and that esophagitis is usually not the cause of dyspepsia in patients without prominent reflux symptoms. They also concluded that the presence of prominent reflux symptoms did not distinguish between patients with or without peptic ulcers.

Comment

The low frequency of endoscopic findings in patients with dyspepsia is consistent with previous studies. However, because the cohort in this trial was recruited from larger populations of patients participating in two studies on gallstones, it might not represent other general populations. There is a significant possibility of selection bias. Of note, the prevalence of H. pylori in this trial (57.7%) was much higher than in most Western populations, which probably contributed to the relatively high prevalence of peptic ulcers. The main message from this study is more likely that the use of a test-and-treat strategy for H. pylori in patients with dyspepsia might be appropriate in populations such as this with high rates of infection.

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