The management of patients with new onset of upper gastro-intestinal symptoms in primary care.
BACKGROUND
Data dealing with dyspepsia management in general practice are lacking, and most of the studies investigated a subset of patients with suspected peptic ulcer disease either with or without previous complaints.


OBJECTIVE
To evaluate the one-year management of patients presenting new onset upper abdominal symptoms without alarming features.


METHODS
275 patients were enrolled by 63 Italian general practitioners.


RESULTS
Referral to upper gastro-intestinal tract endoscopy resulted significantly higher in patients with predominant epigastric pain compared to subjects with non-painful symptoms or non-dominant symptoms. Amongst drug therapies, only prokinetics and antacids and anti-secretory therapies were prescribed differently amongst clinical subgroups. The rate and type of management and referrals resulted were not influenced by the age of patients or the use of anti-inflammatory drugs. The most frequent diagnosis at one-year follow-up was reflux oesophagitis. The absence of organic disease was less frequent in patients with dominant epigastric pain than non-painful or non-dominant symptoms.


CONCLUSIONS
The management of these patients in primary care in Italy is mainly determined by clinical presentation, independent of age. Any judgement about appropriateness of the treatment should consider not only conventional features such as age, but the more complex individual frameworks as well.
Tosetti
Cesare
C
Primary Care Gastroenterology Study Group of the Italian Society of Gastroenterology (SIGE), Italy. tosetti@libero.it
Bellentani
Stefano
S
Benedetto
Edoardo
E
Ubaldi
Enzo
E
Cardin
Fabrizio
F
Bozzani
Alberto
A
D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004415:Dyspepsia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000175:diagnosis / Q000628:therapy; D011320:Primary Health Care; D011364:Professional Practice; D055815:Young Adult