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


METHODS
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.
Stanghellini
V
V
Department of Internal Medicine and Gastroenterology, University of Bologna, Italy.
Anti
M
M
Bianchi Porro
G
G
Corinaldesi
R
R
Gasbarrini
G
G
Giacosa
A
A
Fiocca
R
R
LaVecchia
C
C
Maconi
G
G
Negri
E
E
D000328:Adult; D000367:Age Factors; D000368:Aged; D000907:Antibodies, Bacterial / Q000097:blood; D003430:Cross-Sectional Studies; D004066:Digestive System Diseases / Q000175:diagnosis* / Q000382:microbiology; D004415:Dyspepsia / Q000175:diagnosis* / Q000382:microbiology; D016099:Endoscopy, Gastrointestinal; D005069:Evaluation Studies as Topic; D005260:Female; D016481:Helicobacter Infections / Q000097:blood / Q000150:complications / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011933:Reagent Kits, Diagnostic; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012737:Sex Factors
D000907:Antibodies, Bacterial; D011933:Reagent Kits, Diagnostic