Consultations and referrals for dyspepsia in general practice - a one yeardatabase survey

Objective-Dyspepsia usually presents first in primary care. There are many reasons for referral including urgent problems (for example, haematemesis a nd melaena), treatment failure, or to exclude serious pathology. Referral w ill change the population characteristics of primary and secondary care dys peptics. Many of the guidelines for primary care dyspepsia, however, are ba sed on secondary care research on these referred patients. The aim of this study was to describe the prevalence of dyspepsia in general practice, the characteristics of patients presenting with dyspepsia in primary care, and the clinical and nonclinical determinants of referral in these patients. Design-Cross sectional survey of the consultation records of patients prese nting with dyspepsia in primary care during a one year period. Methods-Dyspeptic patients who consulted their general practitioner (GP) in 1997 were selected on the basis of International Classification of Primary Care codes using a computer search among 20 sentinel practices affiliated with the Utrecht Network of General Practitioners. Gross tables and logisti c regression analysis were carried out to reveal patient characteristics an d determinants of referral. Results-The prevalence of dyspepsia presenting in primary care in 1997 was 3.4% (1740/48958). These patients were usually not referred during the firs t consultation. Men, elderly patients, and patients with a previous history of dyspepsia were referred to secondary care more frequently than other dy speptic patients. Patients diagnosed with both irritable bowel syndrome and dyspepsia were at risk of being referred most. Conclusion-Dyspepsia is a frequently occurring complaint in primary care an d patients are usually treated by their GP. Besides clinically relevant rea sons for referral, dyspeptic patients with irritable bowel syndrome seem to be more "at risk" of being referred to secondary care than other dyspeptic patients. The differences between primary and secondary care dyspeptic pat ients should be taken into account when interpreting research for guideline purposes. Further research is needed to clarify the background of the rela tion between irritable bowel syndrome and dyspepsia and its influence on re ferral.