Predictors and Non-Predictors of Symptom Relief in Dyspepsia Consultations in Primary Care

Abstract

Objective: We aimed to evaluate if the course of dyspepsia is influenced by medical consultation in primary care. Design, Setting and Patients: Australian general practitioners (n = 27) recruited 157 dyspeptic patients, of whom 94 were eligible for follow-up. Dyspepsia, comorbidity, quality of life, emotional status, locus of control and consultation satisfaction were measured at baseline and follow-up (mean 3 months). Main Outcome Measure: Response was defined as improvement of dyspepsia over time on the Nepean Dyspepsia Index score. Results: Dyspepsia improved in 82% (n = 77). There was no significant change in non-gastrointestinal symptoms. Half were worried or stressed by their symptoms, and 85% wanted reassurance, a need that (univariately) differentiated responders from non-responders (p = 0.02). Most patients seen in primary care with dyspepsia improved. If the doctor believed it was likely that the patient would follow their recommendations, the patient was nearly five times as likely to be a responder (OR 4.9, 95% CI 1.2–19.0). The only other significant predictor was acid suppression therapy (OR 3.5, 95% CI 1.1–10.9). Conclusion: Most primary care visits for dyspepsia are followed by improvement, which may be predicted in part by indicators of patient compliance. Prescription of acid suppression therapy may also improve outcome in dyspepsia.