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

Aliment Pharmacol Ther. 2003 Jun 15;17(12):1481-91. doi: 10.1046/j.1365-2036.2003.01646.x.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Aspirin / therapeutic use
  • Barrett Esophagus / diagnosis
  • Dyspepsia / etiology*
  • Endoscopy, Gastrointestinal / adverse effects
  • Endoscopy, Gastrointestinal / standards
  • Esophagitis / diagnosis
  • Female
  • Gastrointestinal Neoplasms / diagnosis
  • Helicobacter Infections / diagnosis
  • Helicobacter pylori
  • Humans
  • Male
  • Middle Aged
  • Peptic Ulcer / diagnosis
  • Predictive Value of Tests
  • Sensitivity and Specificity
  • Stomach Diseases / diagnosis

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Aspirin