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Digestive Diseases and Sciences
Published in: Digestive Diseases and Sciences 10/2016

01-10-2016 | Original Article

The Initial Management and Endoscopic Outcomes of Dyspepsia in a Low-Risk Patient Population

Authors: Jeffrey P. Fiorenza, Alex M. Tinianow, Walter W. Chan

Published in: Digestive Diseases and Sciences | Issue 10/2016

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Abstract

Background and Aims

Dyspepsia is frequently encountered by primary care providers (PCP) and gastroenterologists (GI). While esophagogastroduodenoscopy (EGD) may be useful, current guidelines suggest a proton pump inhibitor (PPI) trial and H. pylori (HP) test-and-treat before EGD for low-risk patients. This study aimed to evaluate pre-EGD management and endoscopic outcomes in this population.

Methods

This was a retrospective cohort study of low-risk dyspepsia patients (age ≤55, no alarm features) undergoing EGD at an ambulatory endoscopy center from January 2011 to March 2012. Adherences to initial management guidelines (PPI trial and HP test-and-treat strategy before EGD) were compared between PCP and GI. Endoscopic and pathologic outcomes were assessed for all patients. Statistical analyses were performed using Chi-squared test (categorical variables) and Student’s t test (continuous variables). This study received IRB approval (2011P001715).

Results

A total of 309 low-risk patients underwent EGD for dyspepsia. Only 202 (65.4 %) had HP testing, and 220 (71.2 %) were trialed on any dose/length PPI pre-EGD, with no differences between PCP and GI. PPI exposure was similar between groups for all dose/duration except for trials ≥8 weeks of any dose (46.9 % GI vs 34.3 % PCP, p = 0.03) and high dose (32 % GI vs 18.7 % PCP, p = 0.01). Overall, only 178 (57.6 %) patients had both HP testing and any PPI exposure pre-EGD (56.6 % GI vs 59 % PCP, p = 0.73). Significant pathology was rare, with gastritis (46.6 %) and HP (17.2 %) being most common. No malignancy was found.

Conclusions

A significant proportion of low-risk dyspepsia patients did not receive any PPI trial or HP testing before EGD. Within this population, significant finding on EGD was rare, supporting the current noninvasive initial management guidelines for dyspepsia.
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Metadata
Title
The Initial Management and Endoscopic Outcomes of Dyspepsia in a Low-Risk Patient Population
Authors
Jeffrey P. Fiorenza
Alex M. Tinianow
Walter W. Chan
Publication date
01-10-2016
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 10/2016
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-016-4051-3

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