Prospective epidemiological study of dyspepsia (PRESTO): basic considerations and preliminary results

Background and objective: Symptoms of dyspepsia (indigestion; upper abdomin al discomfort) are one of the most frequent reasons for consulting a genera l practitioner or internist. Yet there are no up-to-date national data on t he epidemiology and course of this symptom complex. Patients and methods: In an open, prospective, multicentre, epidemiological study (PRESTO) 3016 patients with the suspected diagnosis of "functional d yspepsia" (1228 males, 1788 females, mean age 50 +/- 15 years) were followe d for 2 years by 983 physicians in private practice (general practitioners or specialists in internal medicine). Patients with proven gastrooesophagea l reflux or peptic ulcer were excluded. Treatment was at the discretion of the physician. Patients were seen after one month (if under treatment) and then at 6, 12, 18 and 24 months. In addition to personal data, (1)symptoms, diagnosis and treatment of the dyspepsia, (2) socioeconomic aspects and (3 ) any limitations and the quality of life of each patient were recorded in a standard manner. Results: At the first interim analysis more than half the patients judged t here situation to be one of "chronic stress" or having to cope with a stres sful event; nearly 50% thought this to be the cause of the symptoms. Concom itant illnesses were present in 63% of patients. Oesophagogastroduodenoscop y with subsequent medication was performed in 20.6%, a trial of medication (usually drugs stimulating gastric motility) in 65%. No medication was init ially given to 14.4% of patients. The most common symptoms were feeling of fullness (92.9%, epigastric pressure sensation (91.5%) and flatulence (87.4 %). Conclusion: These preliminary results indicate that a large epidemiological study can be performed by general practitioners and has advantages over th e more usual method of enquiry by telephone. Dyspepsia exerts an unusually high degree of stress and results in considerable demands on medical facili ties.