Appropriateness of indications for diagnostic upper gastrointestinal endoscopy: association with relevant endoscopic disease.
BACKGROUND
Since the institution of open access endoscopy units there has been a considerable increase of referrals for UGI examinations. Therefore, guidelines for the appropriate use of UGI endoscopy are needed.


METHODS
The outcome of first diagnostic UGI endoscopy was prospectively assessed for several referral indications in a consecutive series of 2900 patients. Indications were judged "appropriate" when significantly (p < 0.01) associated with clinically "relevant" endoscopic findings.


RESULTS
The proportion of relevant disease for various indications was as follows: signs of UGI bleeding (42.2%); history of peptic ulcer (40.5%); dysphagia (31.9%), short-term (24.4%), and without therapy (20.9%). Relevant endoscopic findings were observed in 21.0% of dyspeptic patients aged 45 years or less, and in 25.3% of those older than 45 years of age.


CONCLUSIONS
The generally approved alarm symptoms should be a reason to perform endoscopy without hesitation. Dyspeptic symptoms, despite adequate empiric treatment, as well as first dyspeptic symptoms in patients older than 45 years should also be a reason for endoscopic investigation. Our results support the strategy to treat patients younger than 45 years who have isolated dyspepsia by a limited course of antipeptic agents, provided that they are seen for re-evaluation within 4 to 6 weeks.
Adang
R P
RP
Department of Gastroenterology and Hepatology, University Hospital, Maastricht, The Netherlands.
Vismans
J F
JF
Talmon
J L
JL
Hasman
A
A
Ambergen
A W
AW
Stockbrügger
R W
RW
D016099:Endoscopy, Gastrointestinal / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data