title: The prevalence of clinically significant endoscopic findings in primary care patients with uninvestigated dyspepsia: the Canadian Adult Dyspepsia Empiric Treatment - Prompt Endoscopy (CADET-PE) study.
abstract: BACKGROUND
  Uninvestigated dyspepsia is common in family practice. The prevalence of clinically significant upper gastrointestinal findings (CSFs) in adult uninvestigated dyspepsia patients, and their predictability based on history, is unknown.
  
  
  METHODS
  Prompt endoscopy was performed within 10 days of referral, in 1040 adult patients presenting with uninvestigated dyspepsia at 49 Canadian family practitioner centres. Subsequent management strategies during a 6-month follow-up period were determined by the individual family practitioners.
  
  
  RESULTS
  CSFs were identified in 58% (603/1040) of patients. Erosive oesophagitis was most common (43%; N = 451); peptic ulcer was uncommon (5.3%; N = 55). Alarm symptoms were uncommon (2.8%; N = 29). Most patients had at least three dyspepsia symptoms, more than 80% had at least six, and approximately half had eight or more. Based on the dominant symptom, 463 (45%) patients had ulcer-like, 393 (38%) had reflux-like and 184 (18%) had dysmotility-like dyspepsia. The patients' dominant symptom was not predictive of endoscopic findings. Oesophagitis was more common in those with dominant reflux-like symptoms and was the most common finding in all subgroups. The prevalence of gastroduodenal findings was similar in all symptom subgroups. Helicobacter pylori (H. pylori) infection (30%; 301/1013) was associated with gastroduodenal findings.
  
  
  CONCLUSIONS
  Dyspepsia subclassifications, based on dominant symptom, are of limited value in predicting the presence and nature of CSFs. Oesophagitis was by far the most common diagnosis (43% of patients). CSFs were common in uninvestigated dyspepsia patients and their nature suggests patients could be initially treated effectively, without endoscopy, using empirical acid suppressive therapy.
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada. alan.thomson@ualberta.ca
authors.forename: A B R
authors.initials: AB
authors.lastname: Thomson
authors.forename: A N
authors.initials: AN
authors.lastname: Barkun
authors.forename: D
authors.initials: D
authors.lastname: Armstrong
authors.forename: N
authors.initials: N
authors.lastname: Chiba
authors.forename: R J
authors.initials: RJ
authors.lastname: White
authors.forename: S
authors.initials: S
authors.lastname: Daniels
authors.forename: S
authors.initials: S
authors.lastname: Escobedo
authors.forename: B
authors.initials: B
authors.lastname: Chakraborty
authors.forename: P
authors.initials: P
authors.lastname: Sinclair
authors.forename: S J O Veldhuyzen
authors.initials: SJ
authors.lastname: Van Zanten
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D001471:Barrett Esophagus / Q000175:diagnosis; D004415:Dyspepsia / Q000209:etiology*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000592:standards; D004941:Esophagitis / Q000175:diagnosis; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis; D016481:Helicobacter Infections / Q000175:diagnosis; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000175:diagnosis; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013272:Stomach Diseases / Q000175:diagnosis
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin