Risk indicators of organic diseases in uninvestigated dyspepsia: a one-week survey in 246 Italian endoscopy units

Eur J Gastroenterol Hepatol. 1999 Oct;11(10):1129-34. doi: 10.1097/00042737-199910000-00009.


Objective: To evaluate the predictive value of demographic and clinical features and of the results of an office-based test for Helicobacter pylori antibodies, in the presence of organic dyspepsia.

Design: Over a 1-week period, 2206 consecutive patients first referred for endoscopy in 246 Italian centres were included.

Methods: Demographic and clinical features, endoscopy findings, and histological diagnosis of H. pylori infection were recorded for all patients. IgG antibodies to H. pylori were determined in 2128 cases by a rapid, immunochromatographic method (Flex Sure HP, S.K.D., San Jose, CA).

Results: Endoscopic abnormalities were found in 939 patients (42.6%). Histologically assessed H. pylori infection was predictive for duodenal ulcer (odds ratio (OR), 6.79; 95% confidence interval (CI), 4.4-10.5). Being male (OR, 1.97; 95% CI, 1.7-2.3), older than 40 years (OR, 1.81; 95% CI, 1.5-2.2), a smoker (OR, 1.88; 95% CI, 1.6-2.3), and presenting nocturnal awakening (OR, 1.62; 95% CI, 1.3-2.0) were independently associated with secondary dyspepsia. Epigastric (OR, 1.50; 95% CI, 1.2-1.9) and retrosternal pain (OR, 1.39; 95% CI, 1.1 -1.8) severe enough to affect the usual activities were predictive of organic diseases. The results of the Flex Sure HP test correlated poorly with histological findings.

Conclusions: Male gender, older age, cigarette smoking, a family history of peptic ulcer, symptoms severe enough to induce awakening, epigastric/retrosternal pain severe enough to influence the usual activities are all independently (although weakly) associated with organic dyspepsia. H. pylori infection is strongly associated with duodenal ulcer, but the rapid test we used was not sensitive enough to achieve clinical utility.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Antibodies, Bacterial / blood
  • Cross-Sectional Studies
  • Digestive System Diseases / diagnosis*
  • Digestive System Diseases / microbiology
  • Dyspepsia / diagnosis*
  • Dyspepsia / microbiology
  • Endoscopy, Gastrointestinal*
  • Evaluation Studies as Topic
  • Female
  • Helicobacter Infections / blood
  • Helicobacter Infections / complications
  • Helicobacter Infections / diagnosis
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Reagent Kits, Diagnostic
  • Risk Factors
  • Sensitivity and Specificity
  • Sex Factors


  • Antibodies, Bacterial
  • Reagent Kits, Diagnostic