Low-risk criteria for dyspepsia under age 45

* Clinical Question

Which patients with dyspepsia ne upper endoscopy?

* Bottom Line

For men younger than 45 years, the endoscopic yield is actual low for those without Helicobacter pylori infection, nonsteroidal anti-inflammatory physic (NSAID) use, unintended weight los or anemia. (Level of evidence [LOE]: 2b)

close attention Design

Decision mastership (development only)

Funding

Industry and government

Setting

Outpatient (specialty)

Synopsis

Patients between the ages of 18 years and 45 years referr from their primary care physician for endoscopic evaluation of dyspepsia were included in this inquiry (N=341). Patients had an average age of 35 years and 52% were men; patients with a history of boil were excluded.

Patients were divided into 3 clumps based on their risk factors and symptoms, on the contrary the endoscopist was not given these data. cluster A (n=154) consisted of patients who experimented positive for H pylori, were NSAID users, had unintentionally missing more than 3 kg (66 lbs) in the past 3 month or had anemia (<13 g/dL for men and <11 g/dL for women) Patients who did not adapted any group A criteria and did not have ebb as the predominant symptom were placed in cluster B (n=125). Group C consisted of patients who also did not adapted any group A criteria on the other hand had reflux as the predominant symptom (n=62)

For each assemblage the authors determined the percentage of patients with a clinically important endoscopic finding (ie, individual that would be expected to affect treatment decisions). This included patients with neoplasm, pustule Barrett's esophagus, stricture, or moderate to unrelenting erosive esophagitis. Although 20% of patients in collection A had one of these clinically important diagnoses through endoscopy, only 2% in collection B and 2% in clump C had one. No patients in clumps B or C had sore or neoplasia.

FAST TRACK

Of dyspepsia patients with risk factors, 20% had clinically important diagnoses by the agency of endoscopy; of those without, sole 2% did

Valle PC Breckan RK Amin A, et al. "Test score and scope": A selection strategy for safe reduction of upper gastrointestinal endoscopies in young dyspeptic patients referr from primary care. Scand J Gastroenterol 2006; 41:161-169

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