Are clinical patterns of dyspepsia a valid guideline for appropriate use of endoscopy? A report on 2253 dyspeptic patients.
Are clinical patterns of dyspepsia a valid guideline for appropriate use of endoscopy? A report on 2253 dyspeptic patients.
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消化不良的临床模式是否可以作为适当使用内窥镜检查的有效指南？
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发表时间：
1993
期刊：
影响因子：
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通讯作者：
Guido Celle
中科院分区：
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作者：
C. Mansi;V. Savarino;Giuseppe Sandro Mela;A. Picciotto;M. Mele;Guido Celle
我们研究了2253例连续消化不良患者，无器质性疾病的临床证据，他们被转介到我们的开放式内窥镜服务。目的是评估消化不良的各种临床模式是否可以被认为是适当使用内镜检查的有效指南。根据消化学类型，我们的患者被定义为1）溃疡样（973例），2）反流样（857例）和3）动力障碍样消化不良（423例）患者。在我们的患者人群中，反映了我市的一般人群，动力障碍样类型的消化不良最不常见（19%），而溃疡样（43%）和反流样（38%）消化不良几乎相当。内镜检查阴性（35.7%）在动力障碍样消化不良中的发生率显著高于溃疡样消化不良（26.3%）和反流样消化不良（25.7%）（p < 5 × 10 - 4）。此外，在运动障碍样消化不良中，我们观察到60岁以下的患者没有恶性肿瘤，50岁以下的患者没有胃溃疡。在后一个亚组的患者（50岁以下），十二指肠溃疡和食管炎是罕见的（发生在只有一个和五个，分别为145例）。在溃疡样和反流样消化不良中，内镜检查异常发生率较高（分别为73.5%和74.1%），且与患者年龄无关。我们的数据表明，50岁以下的运动障碍样消化不良患者可以被认为是一种不适合内镜检查的人群。然而，由于在我们的样本中运动障碍样消化不良的患病率为19%（423/2253），其中只有7.15%（161/2253）的患者年龄小于50岁，如果采用年龄< 50岁的指南，我们只能获得很小比例的内镜服务负荷减少。
We studied 2253 consecutive dyspeptic patients, without clinical evidence of organic disease, who were referred to our open access endoscopy service. The aim was to assess whether the various clinical patterns of dyspepsia can be considered a valid guideline for the appropriate use of endoscopy. According to the symptomatological patterns, our patients were defined as sufferers from 1) ulcer-like (973 patients), 2) reflux-like (857), and 3) dysmotility-like dyspepsia (423). In our patient population, which reflects the general population of our city, the dysmotility-like type of dyspepsia was the least frequent (19%), whereas the ulcer-like (43%) and the reflux-like (38%) dyspepsia were almost equivalent. A negative endoscopy (35.7%) occurred significantly (p < 5 x 10(-4)) more often in dysmotility-like than in ulcer-like (26.3%) and reflux-like dyspepsia (25.7%). Furthermore, in dysmotility-like dyspepsia, we observed no malignancies in patients less than 60 yr old, and no gastric ulcers in patients less than 50 yr old. In the latter subgroup of patients (under 50 yr), duodenal ulcers and esophagitis were rare (occurring in only one and five, respectively, out of 145 patients). In ulcer-like and reflux-like dyspepsia, abnormal endoscopic findings occurred frequently (in 73.5% and 74.1%, respectively), and no relationship with patients' age was observed. Our data indicate that patients under 50 yr old with dysmotility-like dyspepsia can be considered a kind of population for which endoscopy is inappropriate. However, because the prevalence of dysmotility-like dyspepsia was 19% (423/2253) in our patient sample, and only 7.15% of them were under 50 yr old (161/2253), we can obtain only a small percentage of reduction in endoscopic service load if the guideline of age < 50 yr is adopted.