DIAGNOSTIC METHODS IN DYSPEPSIA - THE USEFULNESS OF UPPER ABDOMINAL ULTRASOUND AND GASTROSCOPY

Objectives - To examine the diagnostic value of gastroscopy and upper abdominal ultrasound, which are frequently used as primary tests in dy speptic patients in general practice, To test the influence of age for accuracy of both diagnostic methods, Design - Clinical study, Setting - Four health centres in Kuopio Province, Finland, Subjects - Four hu ndred unselected consecutive dyspeptic patients (91 less than 45 years of age) who consulted their general practitioners. Main outcome measu res - Sensitivity, specificity, positive and negative predictive value s (PV), efficiency and usefulness index (UI) were calculated for upper abdominal ultrasound and for gastroscopy in detecting the causes of d yspepsia in primary care. Final diagnosis was determined after one yea r follow-up, Results - The sensitivity of upper abdominal ultrasound i n detecting the cause of dyspepsia was 0.07, the specificity 0.91, PV 0.36, PV- 0.56, and UI -0.001, Ultrasound was not more efficient in o lder patients, Gastroscopy was the most efficient method with a sensit ivity of 0.75, specificity 1.00, PV+ 0.99, PV- 0.83 and UI 0.56, The u sefulness of gastroscopy was even better among patients over 45 years of age, Conclusions - The usefulness of upper abdominal ultrasound is low regardless of patient's age. Gastroscopy is superior to upper abdo minal ultrasound as a first line diagnostic method in diagnosing dyspe psia, especially among patients over 45 years of age.