Accuracy of provisional diagnoses of dyspepsia in patients undergoing first endoscopy

Background: This study assessed agreement between provisional and endoscopi c diagnoses for patients with dyspepsia undergoing initial endoscopy, and e xamined variation between clinicians at 2 hospitals. Methods: This was a retrospective review of 423 consecutive patients. Results: Crude percentage agreement ranged from 55% to 97%, Kappa scores re vealed poor agreement: peptic ulcers (0.11:95% CI [0.05, 0.17]); gastroesop hageal reflux disease (0.29: 95% CI [0.20, 0.38]); benign esophageal strict ure (0.33: 95% CI [0.08, 0.58]); and cancer (0.12: 95% CI [-0.12, 0.36]), P ositive and negative predictive values for cancer and benign esophageal str icture showed that agreement for a negative diagnosis was almost perfect, w hereas agreement for a positive diagnosis was low, Only 17% of patients wit h cancer were given an accurate provisional diagnosis. Accuracy of diagnosi s did not vary substantially between hospitals. Conclusions: Crude percentage agreement is misleading, Emphasis should be p laced on better prediction of cancer, benign esophageal stricture, and pept ic ulcer disease, Accuracy of provisional diagnosis in everyday practice is no worse than that found in prospective studies in which clinicians knew a priori that diagnoses would be scrutinized,The difficulty of predicting di agnoses supports increased reliance on endoscopy.