[The prediction of the endoscopic diagnosis in the dyspepsia patient: the value of the predominating presenting symptom and the initial clinical presumption].
OBJECTIVE
To assess, in our patient population, whether upper gastrointestinal symptoms can be used to predict the presence of relevant pathology on endoscopy.


METHODS
In the first retrospective phase, 311 gastroscopies, indicated for dyspeptic symptoms were selected. The gastroscopies were performed by the same endoscopist from April 1998 to March 1999. Patients were divided into four groups according to the main presenting symptom (epigastralgia, epigastralgia with pyrosis, pyrosis with nonspecific symptoms). The positive and negative predictive value, as well as the overall sensitivity and specificity of each group of symptoms for the presentation of a relevant pathology were calculated. In the second, prospective, phase an attempt was made, based on the clinical history taken in the initial consultation, to predict the results of the gastroscopies of 77 dyspeptic patients. There were four possibilities: normal or not relevant, esophagitis, ulcer and neoplasia. The positive predictive value, negative predictive value, sensitivity and specificity of the diagnostic hypothesis were calculated.


RESULTS
a) Retrospective phase: the overall positive predictive value of dyspeptic symptoms to predict relevant pathology was 0.38. The highest positive predictive value corresponded to symptoms of pyrosis (0.48). Dividing the patients into groups according to age (older or younger than 45 years) did not improve the predictive value of symptoms. b) Prospective phase: the highest positive predictive value corresponded to "pathology without relevance" (0.7). The prediction of ulcer only gave a positive predictive value of 0.55.


CONCLUSIONS
The main presenting symptom is not a good predictor of whether relevant pathology will be found on gastroscopy. The initial diagnostic hypothesis is not a sufficiently effective tool to accurately detect which patients will most benefit from gastroscopy.
Bustamante
M
M
Servicio de Medicina Interna, Hospital Francesc de Borja, Gandía, Valencia. mbustamanteb@medynet.com
Ferrando
M J
MJ
Devesa
F
F
Borghol
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004415:Dyspepsia / Q000175:diagnosis*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006356:Heartburn / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity