ARE CLINICAL-PATTERNS OF DYSPEPSIA A VALID GUIDELINE FOR APPROPRIATE USE OF ENDOSCOPY - A REPORT ON 2253 DYSPEPTIC PATIENTS

We studied 2253 consecutive dyspeptic patients, without clinical evide nce of organic disease, who were referred to our open access endoscopy service. The aim was to assess whether the various clinical patterns of dyspepsia can be considered a valid guideline for the appropriate u se of endoscopy. According to the symptomatological patterns, our pati ents were defined as sufferers from 1) ulcer-like (973 patients), 2) r eflux-like (857), and 3) dysmotility-like dyspepsia (423). In our pati ent population, which reflects the general population of our city, the dysmotility-like type of dyspepsia was the least frequent (19%), wher eas the ulcer-like (43%) and the reflux-like (38%) dyspepsia were almo st equivalent. A negative endoscopy (35.7%) occurred significantly (p < 5 x 10(-4)) more often in dysmotility-like than in ulcer-like (26.3% ) and reflux-like dyspepsia (25.7%). Furthermore, in dysmotility-like dyspepsia, we observed no malignancies in patients less than 60 yr old , and no gastric ulcers in patients less than 50 yr old. In the latter subgroup of patients (under 50 yr), duo denal ulcers and esophagitis were rare (occurring in only one and five, respectively, out of 145 pa tients). In ulcer-like and reflux-like dyspepsia, abnormal endoscopic findings occurred frequently (in 73.5% and 74.1%, respectively), and n o relationship with patients' age was observed. Our data indicate that patients under 50 yr old with dysmotility-like dyspepsia can be consi dered a kind of population for which endoscopy is inappropriate. Howev er, because the prevalence of dysmotility-like dyspepsia was 19% (423/ 2253) in our patient sample, and only 7.15% of them were under 50 yr o ld (161/2253), we can obtain only a small percentage of reduction in e ndoscopic service load if the guideline of age < 50 yr is adopted.