ENDOSCOPIC FINDINGS IN VOLUNTEERS AND IN PATIENTS WITH DYSPEPSIA

Although more than a fourth of the adult population reports dyspeptic complaints, little is known about the prevalence of clinically relevan t UGI endoscopic findings in these patients in comparison with asympto matic volunteers. This type of information is required in order to ass ess the relative risks of organic dyspepsia and the sensitivity and sp ecificity of dyspeptic complaints for peptic lesions. In an attempt to fill this gap, the authors compared two trials carried out in the Ger man-speaking part of Switzerland: (a.) 172 adult asymptomatic voluntee rs (age 20-78 years, 74 females, 98 males) participated in an epidemio logical trial to measure the prevalence of positive CLO-urease tests a nd of upper GI-tract lesions. (b.) 119 patients (age 18-84 years; 68 f emales, 51 males) consulting their family doctor because of upper dige stive symptoms of at least 1 month's duration (epigastric pain or disc omfort, heartburn, acid regurgitation, early satiety, bloating, etc.) were referred for UGI endoscopy as a screening procedure; functional d yspeptics were thereafter randomized to a double blind drug trial (not reported here). In both trials the gastric presence of Helicobacter p ylori was measured by means of the CLO-urease test. Prevalences of les ions and of positive urease-tests in the dyspeptic population were com pared with the sex and age adjusted prevalences registered in the cont rol population. The prevalences found (patients vs. volunteers) were a s follows: Relevant peptic lesions (reflux esophagitis, gastric and du odenal ulcers) in 23.5% vs. 7.1% (p<0.05) and 10.3% vs. 5.4% (n.s.) in males and females; erosions and gastritis were found in 19.6% vs. 10. 6% and 2.9% vs. 9.6% in males and females (n.s.). The urease test was positive in 53.2% vs. 13.7% (p<0.01) and 34.9% vs. 24.9% (n.s.) males and females respectively. While in sufferers about 1 out of 5-6 endosc opies will yield a clinically relevant finding regardless of age (abou t twice as often in males as in females), the ratio in volunteers rise s dramatically from about 1:36 in those aged below 50 years to about 1 :6 in those aged 50 years or over. The sensitivity of dyspeptic sympto ms as an indicator of endoscopically detectable lesions can be estimat ed at about 55% (28-70%) in the younger population; in those aged 50 o r more it can be estimated at 23% (8-37%). In view of the increased ri sk of cancer in the older population, an exhaustive diagnostic workup seems warranted even in the presence of only minor subjective symptoms .