Dyspepsia Consulters and Patterns of Management
Dyspepsia Consulters and Patterns of Management
Background: Although dyspepsia is common, management patterns in the United States are unknown.
Aim: To determine the pattern of dyspepsia evaluation and treatment over 20 years in a population-based cohort, and test the hypothesis that the management was influenced by dyspepsia subgroup and gender.
Methods: The validated Bowel Disease Questionnaire was mailed to a random sample of Olmsted County, Minnesota residents (1988-1990). Of the 835 survey respondents, 213 subjects were identified as having dyspepsia according to Rome I Criteria. The medical chart of each dyspeptic subject who had not denied research authorization (n = 206) was reviewed to identify all episodes of care for dyspepsia symptoms 10 years before and 10 years after the date the Bowel Disease Questionnaire was completed. Of these 206 subjects (mean age 47 years, 48% female), 34% had ulcer-like dyspepsia, 32% had dysmotility-like dyspepsia, and 37% had reflux-like dyspepsia.
Results: Nearly half (n = 98, 48%) had episodes of care for dyspepsia symptoms over 20 years. Of these 98 subjects, 49% had upper gastrointestinal endoscopy, 4% motility studies and 12% were tested for Helicobacter pylori. At the first visit of the episode of care closest to Bowel Disease Questionnaire completion, 72% were seen in primary care, 16% in emergency medicine and 2% in gastroenterology. In addition, 13% were referred to gastroenterology clinic within this episode. During the study period, 70% were given an 'acid' diagnosis, 7% a 'motility' diagnosis and 54% a 'functional' diagnosis; 78% received acid suppression agents (28% proton pump inhibitors), 18% psychotropic agents and 7% prokinetic agents. No significant association was found between gender and test usage, specialty referral or type of treatment, although women were three times less likely to receive proton pump inhibitors (odds ratio 3.3, 95% CI: 1.2-9.1). Symptom severity, frequency and pattern were risk factors for health care seeking in dyspepsia.
Conclusions: Delivery of care for dyspepsia was similar among dyspepsia subgroups and in men and women.
Upper abdominal pain or discomfort is common in the general population. The annual prevalence of recurrent upper abdominal pain or discomfort in the United States and other Western countries is approximately 25%. Although fewer than half of dyspepsia sufferers seek medical care for their complaints in the United States and Europe, the problem is responsible for 2-5% of visits to primary care physician. Therefore, dyspepsia and its management are important clinical issues for both primary care physicians and gastroenterologists.
Most patients presenting with dyspepsia suffer from functional dyspepsia (FD) or gastro-oesophageal reflux disease (GERD). The factors that determine whether a patient with dyspepsia consults a physician are poorly defined. There is a general tendency for females to report more gastrointestinal (GI) symptoms including upper abdominal pain or discomfort and women seek health care for FD and irritable bowel syndrome (IBS) significantly more often than do men. Symptom severity is also an important factor, but probably only explains a small proportion of health care seeking behaviour associated with dyspepsia. Psychosocial factors have also been found to characterize those who seek help vs. those who do not. A serious deficiency of studies measuring health care seeking for dyspepsia is the heavy reliance on unvalidated self-report indicators of physician consultation.
Further, the pattern of evaluation and treatment of community patients with dyspepsia who seek health care is unknown in the United States. Clinic-based studies from Europe report low rates of specialist consultation or investigation for dyspepsia. Data taken from gastroenterology clinic-based studies are limited by referral bias and thus, may not accurately reflect the pattern of disease in the community.
Some clinical and pathophysiological studies suggests the existence of two main subgroups in patients with FD, characterized by: (i) male gender, predominant epigastric pain, normal gastric emptying; and (ii) female gender, predominant non-painful symptoms, delayed gastric emptying, and a significant overlap of symptoms with other functional bowel disorders. Based on this evidence, it is likely that gender-related differences exist in the pattern of evaluation and treatment of dyspepsia; however, gender-based differences have not been evaluated in the management of dyspepsia.
The aims of this study were: (i) to evaluate management of dyspepsia in the community by linking population-based data on reported symptoms with comprehensive clinic data; and (ii) to determine whether delivery of health care for dyspepsia was similar among the dyspepsia subgroups and for men and women.
Background: Although dyspepsia is common, management patterns in the United States are unknown.
Aim: To determine the pattern of dyspepsia evaluation and treatment over 20 years in a population-based cohort, and test the hypothesis that the management was influenced by dyspepsia subgroup and gender.
Methods: The validated Bowel Disease Questionnaire was mailed to a random sample of Olmsted County, Minnesota residents (1988-1990). Of the 835 survey respondents, 213 subjects were identified as having dyspepsia according to Rome I Criteria. The medical chart of each dyspeptic subject who had not denied research authorization (n = 206) was reviewed to identify all episodes of care for dyspepsia symptoms 10 years before and 10 years after the date the Bowel Disease Questionnaire was completed. Of these 206 subjects (mean age 47 years, 48% female), 34% had ulcer-like dyspepsia, 32% had dysmotility-like dyspepsia, and 37% had reflux-like dyspepsia.
Results: Nearly half (n = 98, 48%) had episodes of care for dyspepsia symptoms over 20 years. Of these 98 subjects, 49% had upper gastrointestinal endoscopy, 4% motility studies and 12% were tested for Helicobacter pylori. At the first visit of the episode of care closest to Bowel Disease Questionnaire completion, 72% were seen in primary care, 16% in emergency medicine and 2% in gastroenterology. In addition, 13% were referred to gastroenterology clinic within this episode. During the study period, 70% were given an 'acid' diagnosis, 7% a 'motility' diagnosis and 54% a 'functional' diagnosis; 78% received acid suppression agents (28% proton pump inhibitors), 18% psychotropic agents and 7% prokinetic agents. No significant association was found between gender and test usage, specialty referral or type of treatment, although women were three times less likely to receive proton pump inhibitors (odds ratio 3.3, 95% CI: 1.2-9.1). Symptom severity, frequency and pattern were risk factors for health care seeking in dyspepsia.
Conclusions: Delivery of care for dyspepsia was similar among dyspepsia subgroups and in men and women.
Upper abdominal pain or discomfort is common in the general population. The annual prevalence of recurrent upper abdominal pain or discomfort in the United States and other Western countries is approximately 25%. Although fewer than half of dyspepsia sufferers seek medical care for their complaints in the United States and Europe, the problem is responsible for 2-5% of visits to primary care physician. Therefore, dyspepsia and its management are important clinical issues for both primary care physicians and gastroenterologists.
Most patients presenting with dyspepsia suffer from functional dyspepsia (FD) or gastro-oesophageal reflux disease (GERD). The factors that determine whether a patient with dyspepsia consults a physician are poorly defined. There is a general tendency for females to report more gastrointestinal (GI) symptoms including upper abdominal pain or discomfort and women seek health care for FD and irritable bowel syndrome (IBS) significantly more often than do men. Symptom severity is also an important factor, but probably only explains a small proportion of health care seeking behaviour associated with dyspepsia. Psychosocial factors have also been found to characterize those who seek help vs. those who do not. A serious deficiency of studies measuring health care seeking for dyspepsia is the heavy reliance on unvalidated self-report indicators of physician consultation.
Further, the pattern of evaluation and treatment of community patients with dyspepsia who seek health care is unknown in the United States. Clinic-based studies from Europe report low rates of specialist consultation or investigation for dyspepsia. Data taken from gastroenterology clinic-based studies are limited by referral bias and thus, may not accurately reflect the pattern of disease in the community.
Some clinical and pathophysiological studies suggests the existence of two main subgroups in patients with FD, characterized by: (i) male gender, predominant epigastric pain, normal gastric emptying; and (ii) female gender, predominant non-painful symptoms, delayed gastric emptying, and a significant overlap of symptoms with other functional bowel disorders. Based on this evidence, it is likely that gender-related differences exist in the pattern of evaluation and treatment of dyspepsia; however, gender-based differences have not been evaluated in the management of dyspepsia.
The aims of this study were: (i) to evaluate management of dyspepsia in the community by linking population-based data on reported symptoms with comprehensive clinic data; and (ii) to determine whether delivery of health care for dyspepsia was similar among the dyspepsia subgroups and for men and women.