Implementation of a guideline versus use of individual prognostic factors to prioritize waiting lists for upper gastrointestinal endoscopy.
BACKGROUND
Studying factors associated with positive gastroscopies in dyspeptic patients can help limit and rationalize waiting lists for endoscopies. Dyspepsia guidelines have a controversial role because their main purpose is to provide specifications on efficient global management of primary care patients.


OBJECTIVE
To assess and weigh the risk of major endoscopic diagnoses against different age groups, gender, Helicobacter pylori infection, compliance with European Society of Primary Care Gastroenterology (ESPCG) guideline statements, and participation of prescribing general practitioners in a quality improvement programme for dyspepsia management, based on these guidelines.


METHODS
We consecutively studied the outcomes of 752 gastroscopies with respect to two sets of useful results: the first considered diagnoses of carcinoma, gastric and duodenal ulcer; the second excluded duodenal ulcer.


RESULTS
A diagnosis of cancer or gastric/duodenal ulcer was associated with male sex (odds ratio (OR)=1.81, P=0.016), age above 41 years (OR=3.24, P=0.009) and particularly with positivity to H. pylori (OR=4.49, P<0.001), while the risk increased by two and a half times in gastroscopies conforming with ESPCG guidelines (OR=2.47, P=0.003). In the second set of analysis, we noted a statistically significant correlation between cancer or gastric ulcer and compliance with ESPCG guidelines (OR=4.69, P=0.013), but not with H. pylori positivity (OR=1.83, P=0.11); a linear relationship was observed across age groups, with a 60% increase in the risk of disease with every 5-year increase in age (OR=1.59, P=0.002).


CONCLUSIONS
Participation of general practitioners in the Dyspepsia Management Programme (DMP) was not significantly associated with a positive gastroscopy.
Cardin
Fabrizio
F
Geriatric Surgery Unit, Geriatric Department, University of Padova, Italy. gerichir@unipd.it
Zorzi
Manuel
M
Terranova
Oreste
O
D000328:Adult; D000367:Age Factors; D000368:Aged; D004415:Dyspepsia / Q000209:etiology*; D005260:Female; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000150:complications; D016480:Helicobacter pylori; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010437:Peptic Ulcer / Q000150:complications / Q000175:diagnosis; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods / Q000592:standards; D011379:Prognosis; D011785:Quality Assurance, Health Care; D012307:Risk Factors; D012737:Sex Factors; D013274:Stomach Neoplasms / Q000150:complications / Q000175:diagnosis; D014850:Waiting Lists