Risk indicators of organic diseases in uninvestigated dyspepsia: a one-week survey in 246 Italian endoscopy units

Objective To evaluate the predictive value of demographic and clinical feat ures and of the results of an office-based test for Helicobacter pylori ant ibodies, in the presence of organic dyspepsia. Design Over a 1-week period, 2206 consecutive patients first referred for e ndoscopy in 246 Italian centres were included. Methods Demographic and clinical features, endoscopy findings, and histolog ical diagnosis of H. pylori infection were recorded for all patients. IgG a ntibodies to H. pylori were determined in 2128 cases by a rapid, immunochro matographic method (Flex Sure HP, S,K.D., San Jose, CA). Results Endoscopic abnormalities were found in 939 patients (42.6%). Histol ogically assessed H. pylori infection was predictive for duodenal ulcer (od ds ratio (OR), 6.79; 95% confidence interval (CI), 4.4-10.5). Being male (O R, 1.97; 95% CI, 1.7-2,3), older than 40 years (OR, 1.81; 95% CI, 1,5-2,2), a smoker (OR, 1.88; 95% CI, 1.6-2.3), and presenting nocturnal awakening ( OR, 1.62; 95% CI, 1.3-2.0) were independently associated with secondary dys pepsia, Epigastric (OR, 1.50; 95% CI, 1.2-1.9) and retrosternal pain (OR, 1 .39; 95% CI, 1.1-1.8) severe enough to affect the usual activities were pre dictive of organic diseases, The results of the Flex Sure HP test correlate d poorly with histological findings. Conclusions Male gender, older age, cigarette smoking, a family history of peptic ulcer, symptoms severe enough to induce awakening, epigastric/retros ternal pain severe enough to influence the usual activities are all indepen dently (although weakly) associated with organic dyspepsia. H. pylori infec tion is strongly associated with duodenal ulcer, but the rapid test we used was not sensitive enough to achieve clinical utility, Eur J Gastroenterol Hepatol 11:1129-1134 (C) 1999 Lippincott Williams & Wilkins.