Open access endoscopy in an epidemiological situation of high prevalence of Helicobacter pylori infection: applicability of the guidelines of the European Society for Primary Care Gastroenterology.

Abstract

Dyspepsia is a common syndrome and provides primary care physicians with a significant workload. To optimize the management of dyspepsia, several guidelines have been developed. The aim of this study was to determine the incidence of upper gastrointestinal diseases and their relationship to Helicobacter pylori infection in dyspeptic patients referred for upper endoscopy by family physicians, as well as to assess the applicability of the guidelines of the European Society for Primary Care Gastroenterology (ESPCG). A total of 168 unselected dyspeptic out-patients (mean age 38 years, range 18-75), 88 male and 80 female, were included. Two biopsies from the antrum and two from the corpus were taken for histological assessment, and one from the antrum and one from the corpus were taken for culture. Half of the patients had clinically significant findings at endoscopy: peptic ulcer which occurred in 35% of the patients under the age of 30 years, in 45% of the patients in the age group 30-44 years and in 36% of the patients over 45 years of age. The prevalence of H. pylori infection in these age groups was 67, 87 and 89%, respectively. Duodenal ulcer was 12 times more common than gastric ulcer. The overall incidence of upper gastrointestinal disease, especially among young dyspeptic patients, was high compared with that observed in Western countries. The characteristics of dyspeptic patients, consulted in primary care, should be used for adaptation of the ESPCG guidelines to local needs.