Predominant symptom behavior in patients with persistent dyspepsia during treatment.
BACKGROUND
Grouping of patients based on a predominant dyspeptic symptom is frequently employed in management strategies for dyspepsia. Such subdivision, however, suggests that dyspeptic symptom patterns are constant over time.


OBJECTIVE
To investigate the behavior of symptoms over time and to study the effects of diagnostic procedures and treatment on the pattern and severity of dyspeptic symptoms.


METHODS
Patients with persistent dyspeptic symptoms completed a validated questionnaire at regular time intervals as part of a clinical trial in primary care. Based on predominant symptoms, patients were classified into ulcer-like dyspepsia, reflux-like dyspepsia, dysmotility-like dyspepsia, and unspecific dyspepsia according to the Rome II criteria.


RESULTS
Questionnaires were returned at baseline, 1, 3, and 6 months by 185, 172, 169, and 170 patients, respectively. At baseline, 35% of patients reported predominantly reflux-like dyspepsia, 34% had ulcer-like dyspepsia, 16% had dysmotility-like dyspepsia, and in 15% symptoms were not specific. During the 6-month follow-up period, only 35% of patients kept the same predominant symptom. Symptom (in)stability was not dependent on diagnostic procedures or on therapy with proton pump inhibitors, H2-receptor antagonists, prokinetics, or antacids.


CONCLUSIONS
In the majority of dyspeptic patients, symptoms change continuously as time goes on. Symptom instability is not influenced by diagnostic procedures or therapy. Thus, there is little sense in symptom-based management of dyspepsia in primary care.
Laheij
Robert J F
RJ
Department of Gastroenterology, University Medical Center St. Radboud, Nijmegen, The Netherlands. R.Laheij@mdl.umcn.nl
De Koning
Ruud W
RW
Horrevorts
Alfonds M
AM
Rongen
Rob J
RJ
Rossum
Leo G M
LG
Witteman
Ellen M
EM
Hermsen
Jan T H
JT
Jansen
Jan B M J
JB
D000328:Adult; D002908:Chronic Disease; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D004415:Dyspepsia / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005746:Gastric Emptying / Q000187:drug effects / Q000502:physiology; D005769:Gastrointestinal Motility; D016481:Helicobacter Infections / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011336:Probability; D011788:Quality of Life; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D016896:Treatment Outcome