Chronic non-specific abdominal complaints in general practice: a prospective study on management, patient health status and course of complaints.
BACKGROUND
While in general practice chronic non-specific abdominal complaints are common, there is insufficient data on the clinical course and the management of these complaints. Aim of this study was to present a primary care based profile of these chronic complaints including health care involvement, health status and clinical course.


METHODS
Thirty general practitioners (GPs) and patients from their practices participated in a prospective follow-up study. All patients and GPs were asked to complete questionnaires at baseline and at 6, 12 and 18 months of follow-up. The GPs provided information on diagnostic and therapeutic management and on referral concerning 619 patients with chronic non-specific abdominal complaints, while 291 patients provided information about health status and clinical course of the complaints.


RESULTS
When asked after 18 months of follow-up, 51,7% of the patients reported an equal or worsened severity of complaints. General health perception was impaired and patients had high scores on SCL-anxiety and SCL-depression scales. Diagnostic tests other than physical examination and laboratory tests were not frequently used. Medication was the most frequent type of treatment. The persistence of chronic non-specific abdominal complaints was quite stable.


CONCLUSIONS
Once non-specific chronic abdominal complaints have become labelled as chronic by the attending physician, little improvement can be expected. The impact on patients' physiological and psychological well-being is large. GPs use a variety of diagnostic and therapeutic strategies. Research into the evidence base of currently applied management strategies is recommended.
van den Heuvel-Janssen
Henriëtte A M
HA
Department of General Practice, Research Institute Caphri, Maastricht University, Maastricht, The Netherlands. jean.muris@hag.unimaas.nl
Borghouts
Jeroen A J
JA
Muris
Jean W M
JW
Koes
Bart W
BW
Bouter
Lex M
LM
Knottnerus
J André
JA
D015746:Abdominal Pain / Q000175:diagnosis* / Q000523:psychology; D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety; D002908:Chronic Disease; D003863:Depression; D004415:Dyspepsia / Q000503:physiopathology; D005194:Family Practice / Q000379:methods*; D005260:Female; D006304:Health Status; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010346:Patient Care Management; D011320:Primary Health Care / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D016896:Treatment Outcome