Abstract
BackgroundIt is important to know the causes of dyspepsia to establish the therapeutic approach. Dyspepsia is a frequent syndrome in our country, where there are restrictions to endoscopy and high prevalence of Helicobacter pylori (H. pylori) infection. This study aimed to assess the endoscopic findings of the syndrome, in an outpatient screening clinic of a tertiary hospital in São Paulo.MethodsOutpatients with uninvestigated dyspepsia, according to Rome III criteria, answered a dyspepsia questionnaire and underwent esophagogastroduodenoscopy. The Rapid Urease Test was applied to fragments of the antral mucosa and epidemiological data were collected from the studied population. Organic dyspepsia findings were analyzed with different variables to verify statistically significant associations.ResultsThree hundred and six patients were included and 282 were analyzed in the study. The mean age was 44 years and women comprised 65% of the sample. Forty-five percent of the patients reported alarm symptoms. Functional dyspepsia was found in 66% of the patients (20% with normal endoscopy results and 46% with gastritis), 18% had GERD and 13% had ulcers (duodenal in 9% and gastric in 4%). Four cases of gastric adenocarcinoma were identified (1.4%), one without alarm characteristics, 1 case of adenocarcinoma of the distal esophagus and 1 case of gastric lymphoma. The prevalence of H. pylori was 54% and infection, age and smoking status were associated with organic dyspepsia. The age of 48 years was indicative of alarm signs.ConclusionsThe endoscopic diagnosis of uninvestigated dyspepsia in our setting showed a predominance of functional disease, whereas cancer was an uncommon finding, despite the high prevalence of H. pylori. Organic dyspepsia was associated with infection, age and smoking status.
Highlights
It is important to know the causes of dyspepsia to establish the therapeutic approach
Three hundred six patients were included, of which 282 were available for analysis: 8 patients dropped from the study, 5 were excluded, as they were using of omeprazole at the time of the endoscopy, 4 had their endoscopy results lost, 3 refused to undergo endoscopy, 3 underwent the endoscopy after more than 30 days and one had a previous abdominal surgery
Our study shows results that are consistent with the meta-analysis by Ford [14], our prevalence of gastroesophageal reflux disease (GERD) was somewhat higher than that of peptic ulcer, whereas malignancy rates were somewhat higher than those observed in that study
Summary
It is important to know the causes of dyspepsia to establish the therapeutic approach. Dyspepsia is a frequent syndrome in our country, where there are restrictions to endoscopy and high prevalence of Helicobacter pylori (H. pylori) infection. Symptom onset must strategy for dyspepsia [12], the establishment of this procedure for every dyspeptic patient may not be practical approach, as the high prevalence of the syndrome will result in very high costs to any health system [13]. As for our country, the very high prevalence of H. pylori infection [19,20,21,22], which requires a complex and expensive treatment for a large number of individuals and the low availability of noninvasive tests for the diagnosis of H. pylori infection make the test and treat approach unfeasible. The age indication for endoscopy has not been determined in our country and the limited availability of this procedure does not allow it to be requested as the initial approach
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