HOW MUCH ULCER IS ULCER-LIKE - DIAGNOSTIC DETERMINANTS OF PEPTIC-ULCER IN OPEN ACCESS GASTROSCOPY

A cross-sectional diagnostic prevalence study was carried out within a multi-center experiment with open access gastroscopy in Utrecht, The Netherlands. The objectives of the study was to contribute to improvem ent of patient selection for open access gastroscopy and to evaluate d iagnostic determinants for peptic ulcer. Data were analysed in all 861 patients who were consecutively newly referred during the experiment to undergo gastrocopy. Patient characteristics and outcomes of gastros copies were recorded. Univariate and multivariate (logistic) analyses were carried out and the results were evaluated with ROC (receiver ope rating characteristic) analysis. The most important clinical character istics to be used for prediction of peptic ulcer are pain on an empty stomach, absence of pain after a meal and absence of obstructive compl aints. The scoring list derived from the full model, comprising these characteristics together with age, sex, information on former dyspepti c diseases, medication and smoking ('basic characteristics'), predicte d peptic ulcer with an AUC of 0.78. The 'ulcer-like' model, with chara cteristics known from the literature, had an AUC of 0.76. The amount o f gastroscopy requests on patient suspected of a peptic ulcer could ha ve been reduced from 60 to 44%. Forcing 'basic characteristics' into s coring lists on peptic ulcer improved the pre-diagnostic test capaciti es. The presented scoring list may improve gastroscopy requesting by G Ps aiming at finding peptic ulcers. Practical manageability of the lis t should be prospectively evaluated in future experiments.