Clinical value of ultrasound in the evaluation of dyspepsia in primary health care.
OBJECTIVE
In general practice, upper abdominal ultrasound (US) is widely used in the evaluation of patients with dyspepsia. However, there is a dearth of published data on the role of US in the dyspepsia work-up. There are no data on the use of US as a follow-up study in functional dyspepsia. The aims of this study were to assess the role of US in evaluating dyspepsia, and to assess the long-term clinical relevance of minor findings revealed by US in patients with functional dyspepsia.


METHODS
Four hundred consecutive dyspeptic patients were recruited. At baseline, all patients underwent gastroscopy and US. Patients were divided into two groups: "endoscopy-negative patients" and "endoscopy-positive patients". "The endoscopy-negative" group included all cases in which the final diagnoses could not be settled after gastroscopy. US was repeated after 6-7 years in patients who had functional dyspepsia.


RESULTS
In the endoscopy-negative group, gallstones were detected in 21 patients, but this was considered to be a cause of symptoms in 9 patients. No malignant lesions were detected by US in the endoscopy-negative group. In the endoscopy-positive group, a malignant tumor in the kidney was suspected in 3 patients. Only one of these tumors turned out to be an incidental small carcinoma. Moreover, several minor findings were shown by US: usually these consisted of abnormal echogenicity of the liver. During the follow-up period, 6 patients developed gallstones. At the end of the follow-up period, two clinically significant findings were diagnosed: a small renal cancer and hydronephrosis.


CONCLUSIONS
This study shows that the wide, untargeted use of abdominal US in the evaluation of patients with dyspepsia following a gastroscopy is not necessary. Repeated US examination in cases of functional dyspepsia is not recommended, and rarely changes the diagnosis.
Heikkinen
Markku
M
Department of Medicine, Unit of Gastroenterology, Kuopio University Hospital, Finland. markku.heikkinen@kuh.fi
Räsänen
Heikki
H
Färkkilä
Martti
M
D003937:Diagnosis, Differential; D018450:Disease Progression; D004415:Dyspepsia / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012189:Retrospective Studies; D014463:Ultrasonography