UPPER GASTROINTESTINAL SYMPTOMS IN GENERAL-PRACTICE - A MULTICENTER UK STUDY

The study was designed to identify patterns of dyspeptic symptoms in p atients presenting to General Practitioners and to determine whether a classification based on published symptom sub-groups con be used to p redict which patients respond best to treatment with a prokinetic. It was a multicentre study involving symptom assessment before and after four weeks' open treatment with 10mg cisapride tid and after a further four-week period without treatment. Patients presenting with dyspepsi a, whom General Practitioners considered suitable for a trial of thera py without prior gastrointestinal investigation, were recruited to the study and their symptoms were recorded. Symptoms were recorded from 9 ,974 patients, of whom 7,928 completed the treatment phase and 5,125 r eturned at the end of the follow-up Period. Symptom occurrence and sev erity were recorded before and after treatment The pattern of symptom presentation was compared with pre-defined symptom sub-groups, and the response rates of different sub-groups to treatment were analysed. On ly half the patients (n=4,518) could be categorised according to the p redefined dyspepsia sub-groups: 27.9% had ulcer-like, 12.1% dysmotilit y-like and 4.1% reflux-like dyspeptic symptoms. The other patients had symptoms associated with more than one sub-group. Symptom patterns an d sub-group distribution were not related to patients' age or sex and showed no regional variation. After four weeks of treatment with cisop ride, 89.9% of patients showed symptom improvement which was sustained for a further four weeks after treatment in most patients (63.3%). Re sponse rates to treatment with cisapride were similar in all sub-group s (range 84-92%). We conclude that symptom sub-groups ore not helpful in predicting response to treatment with a prokinetic.