"Test, score and scope": a selection strategy for safe reduction of upper gastrointestinal endoscopies in young dyspeptic patients referred from primary care.
OBJECTIVE
To test the ability of pre-endoscopic clinical evaluation to predict clinically relevant findings of upper gastrointestinal endoscopy.


METHODS
Patients (341) who had been referred to upper gastrointestinal endoscopy for further evaluation of dyspeptic symptoms were included in this prospective, single-blinded study. Prior to endoscopy, the patients underwent a standardized clinical evaluation consisting of 1) a symptom questionnaire, 2) serological testing for Helicobacter pylori antibody and 3) determination of blood hemoglobin. Based upon this evaluation, patients were assigned to one of three defined risk groups. Group A comprised patients with known risk factors for diseases that would require further therapeutic or diagnostic management. Patients in groups B and C had no such risk factors. Patients in group C had heartburn or regurgitation as a predominant symptom, whereas patients in group B did not. The prevalence of clinically relevant findings upon upper endoscopy was then compared for these three groups.


RESULTS
The prevalence of clinically relevant endoscopic findings in risk groups A, B and C were 20.1, 2.4 and 1.6%, respectively (p<0.01 for both A versus B and A versus C). Furthermore, 89% of those with clinically relevant endoscopic findings belonged to group A, which comprised a total of 45% of the patients studied. In groups B and C, the prevalence of disease was similar to the area-specific prevalence in the general population without dyspeptic symptoms.


CONCLUSIONS
By using a simple standardized questionnaire, H. pylori serology and a hemoglobin reading in the evaluation of dyspeptic patients under 45 years of age, the need for endoscopy can be reduced by 55%.
Department of Internal Medicine, Hålogaland Hospital, Harstad, Norway. per.valle@Harstad-sykehus.no
Per C
PC
Valle
Ragnar K
RK
Breckan
Anil
A
Amin
Magnhild Gangsøy
MG
Kristiansen
Einar
E
Husebye
Kåre
K
Nordgård
Liisa
L
Mortensen
Odd A
OA
Kildahl-Andersen
Anna M
AM
Wessel-Berg
D000293:Adolescent; D000328:Adult; D004415:Dyspepsia / Q000175:diagnosis*; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011320:Primary Health Care; D011446:Prospective Studies; D012017:Referral and Consultation; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D011795:Surveys and Questionnaires