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30-03-2010 | Gastroenterology | Article

Links between endoscopic findings and dyspeptic symptoms clarified

Abstract

Free abstract

MedWire News: About 75% of people who experience dyspeptic symptoms do not have endoscopic findings, report researchers.

In addition, their findings showed that esophagitis was only significantly associated with dyspeptic symptoms in patients who also had prominent reflux symptoms, while peptic ulcers were linked to dyspepsia both in the presence and absence of reflux.

Franco Bazzoli (University of Bologna, Italy) and colleagues evaluated the prevalence of endoscopic findings and their association with dyspepsia in 1033 inhabitants of two Italian villages.

All participants filled out a validated dyspepsia questionnaire, had an upper gastrointestinal endoscopy, and underwent a 13C-urea breath test.

The investigators report that 552 participants were asymptomatic, 404 had clinically significant gastrointestinal symptoms (at least 2 days/week) with no alarm signs or symptoms, such as difficulty or pain on swallowing, recurrent vomiting, unexplained weight loss, or signs of upper gastrointestinal bleeding, and 77 had dyspepsia with alarm signs or symptoms.

Of the 404 patients without alarm signs/symptoms, 149 and 136 had dyspepsia with and without concurrent prominent reflux symptoms, respectively. The remaining 119 had reflux symptoms, nausea, or bloating alone.

The team observed endoscopic findings in 23.2% of the cohort overall, affecting 17.6% of the asymptomatic and 27.4% of the dyspeptic individuals.

Esophagitis and Barrett’s esophagus were significantly more common in patients with dyspepsia and prominent reflux symptoms than those with dyspepsia without reflux symptoms, at 16.8% and 3.4% versus 8.1% and 1.5%, respectively. Barrett’s esophagus was less common in asymptomatic individuals, at 0.7%, but the researchers say “the small number makes meaningful inference impossible.”

Of note, the prevalence of esophagitis in patients with dyspepsia but no reflux symptoms was not significantly different from that in asymptomatic individuals (8.1% and 8.5%, respectively), suggesting that esophagitis was not associated with dyspeptic symptoms alone.

Peptic ulcer was recorded in 8.8% and 9.4% of patients with dyspepsia alone and dyspepsia with reflux symptoms, respectively. Individuals with dyspepsia and reflux symptoms or dyspepsia alone were 2.74 and 2.36 times more likely to have an underlying peptic ulcer, respectively, than asymptomatic participants.

“We found that peptic ulcer was the only endoscopic finding associated with the presence of dyspeptic symptoms in subjects without prominent reflux symptoms,” conclude the authors in the American Journal of Gastroenterology.

“Another relevant finding was that subjects with dyspeptic symptoms and concomitant prominent reflux symptoms had an increased risk of peptic ulcer, in addition to the expected increased risk of esophagitis.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Helen Albert