title: The Initial Management and Endoscopic Outcomes of Dyspepsia in a Low-Risk Patient Population.
abstract: Dyspepsia is frequently encountered by primary care providers (PCP) and gastroenterologists (GI). While esophagogastroduodenoscopy (EGD) may be useful, current guidelines suggest a proton pump inhibitor (PPI) trial and H. pylori (HP) test-and-treat before EGD for low-risk patients. This study aimed to evaluate pre-EGD management and endoscopic outcomes in this population.
  
  
  
  This was a retrospective cohort study of low-risk dyspepsia patients (age ≤55, no alarm features) undergoing EGD at an ambulatory endoscopy center from January 2011 to March 2012. Adherences to initial management guidelines (PPI trial and HP test-and-treat strategy before EGD) were compared between PCP and GI. Endoscopic and pathologic outcomes were assessed for all patients. Statistical analyses were performed using Chi-squared test (categorical variables) and Student's t test (continuous variables). This study received IRB approval (2011P001715).
  
  
  
  A total of 309 low-risk patients underwent EGD for dyspepsia. Only 202 (65.4 %) had HP testing, and 220 (71.2 %) were trialed on any dose/length PPI pre-EGD, with no differences between PCP and GI. PPI exposure was similar between groups for all dose/duration except for trials ≥8 weeks of any dose (46.9 % GI vs 34.3 % PCP, p = 0.03) and high dose (32 % GI vs 18.7 % PCP, p = 0.01). Overall, only 178 (57.6 %) patients had both HP testing and any PPI exposure pre-EGD (56.6 % GI vs 59 % PCP, p = 0.73). Significant pathology was rare, with gastritis (46.6 %) and HP (17.2 %) being most common. No malignancy was found.
  
  
  
  A significant proportion of low-risk dyspepsia patients did not receive any PPI trial or HP testing before EGD. Within this population, significant finding on EGD was rare, supporting the current noninvasive initial management guidelines for dyspepsia.
authors: Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.|Harvard Medical School, Boston, MA, USA.
authors: Jeffrey P
authors: JP
authors: Fiorenza
authors: Harvard School of Public Health, Boston, MA, USA.
authors: Alex M
authors: AM
authors: Tinianow
authors: Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. wwchan@bwh.harvard.edu.|Harvard Medical School, Boston, MA, USA. wwchan@bwh.harvard.edu.
authors: Walter W
authors: 0000-0002-1709-8230
authors: WW
authors: Chan
mesh_terms: D000328:Adult; D015331:Cohort Studies; D019468:Disease Management; D004415:Dyspepsia / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D016145:Endoscopy, Digestive System; D005260:Female; D005756:Gastritis / Q000175:diagnosis* / Q000473:pathology; D000072102:Gastroenterologists / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D018570:Risk Assessment
chemical_list: D054328:Proton Pump Inhibitors
keywords: Alarm features; Esophagogastroduodenoscopy; Helicobacter pylori; Proton pump inhibitor