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Introduction: This study describes unsedated transnasal oesophagogastroduodenoscopy (UT-OGD) in the office setting. Evaluation of national guidelines regarding primary endoscopy for the investigation of upper gastrointestinal (GI) symptoms was also a focus of this study., Material and Methods: Retrospective registration of 2,000 cases regarding demographics, symptoms, pre-endoscopic treatment, feasibility and findings., Results: The proportion of males was 42%. 19% of the patients were referred due to alarm symptoms. The transnasal feasibility was 97%. Endoscopic findings: No abnormal findings (NAF) 53%, hiatal hernia 25%, oesophagitis 11%, gastric inflammation 11%, ulcer 10%, cancer 1% and others 1%. Alarm symptoms (AS) versus non-alarm symptoms (NAS): 35% of patients with AS had NAF versus 58% in the NAS group (p < 0.001). Cancer was present in 4% of the cases in the AS group versus 0.1% in the NAS group (p < 0.001). < 45 years versus ≥ 45 years: 69% of patients < 45 years had NAF versus 45% of patients ≥ 45 years (p < 0.001). Cancer was present in 0% of the cases in those < 45 years versus 1.4% in those ≥ 45 years (p = 0.002)., Conclusion: UT-OGD in private practice had a higher proportion of females than similar procedures performed in hospital settings. Feasibility was high. Endoscopic findings were comparable to those reported by other studies, except for a lower prevalence of oesophagitis. Age < 45 years and absence of alarm symptoms were strong negative predictors for the presence upper GI cancer. Our data thus seem to confirm the Danish guideline regarding primary endoscopy for the investigation of upper GI symptoms.

Objectives: The optimal approach for management of patients with dyspepsia has not been determined. The aim of this study was to compare the efficacy of three strategies for management of dyspepsia: empirical antisecretory therapy, testing for Helicobacter pylori (H. pylori), or a combination of the two., Methods: Cluster-randomized trial in general practices. Initial treatment with proton pump inhibitor (PPI) was performed in 222 patients, H. pylori test-and-eradicate in 250 patients, and PPI followed by H. pylori-testing if symptoms improved in 250 patients. Symptoms, quality of life, patient satisfaction, and use of resources were recorded during a 1-yr follow-up., Results: The prevalence of H. pylori infection was 24%. We found no difference among the three strategies (p=0.16) in terms of the proportion of days without dyspeptic symptoms. After 1 yr gastrointestinal symptom scores and quality-of-life scores had improved significantly and equally in the three groups (p<0.001), but no statistically significant differences were found among the groups. The mean use of endoscopies per patient after 1 yr was higher in the PPI group (0.36 [95% CI 0.30-0.43]) than in the test-and-eradicate group (0.28 [95% CI 0.23-0.34]) and the combination group (0.22 [95% CI 0.17-0.27]), p=0.02. H. pylori-positive patients given eradication therapy had more days without dyspeptic symptoms (p<0.001), used less antisecretory therapy (p<0.01), and were more satisfied (p<0.001) than H. pylori-negative patients., Conclusion: The strategies based on H. pylori test enjoyed similar symptom resolution, but reduced endoscopic workload and lower 1-yr total costs compared with empirical antisecretory therapy.

Objective: The effect of omeprazole therapy in dyspepsia is unpredictable. The aim of this study was to identify patient characteristics and symptoms associated with the omeprazole response to improve selection of patients for empirical treatment with omeprazole., Methods: Data from a randomized controlled trial of 471 patients with ulcer-like or reflux-like dyspepsia treated with omeprazole 20 mg daily (243 patients) or placebo (228 patients) for 2 wk were studied using logistic regression analysis. The patients were randomly divided into a model sample (N = 236) for modeling the association between the omeprazole response and descriptive variables, and a test sample (N = 235) for testing the obtained model., Results: In the model sample a high body mass index, the use of antacids or H2-blockers within the last month, or pain at night time were independently associated with a good omeprazole response, whereas the presence of nausea was associated with a poor omeprazole response. Using these variables combined into a therapeutic index, the independent test sample patients could be classified into predicted good (N = 56), medium (N = 88), and poor omeprazole responders (N = 91). In these groups the observed therapeutic gain of omeprazole (omeprazole response minus placebo response) was 39.4%, 19.3%, and 4.6%, respectively (p = 0.013). For clinical use, an easy-to-use pocket chart to obtain the therapeutic index in a given patient has been devised., Conclusions: In dyspepsia the identification of potential responders to omeprazole can be improved by considering certain patient characteristics and symptoms associated with the omeprazole response. Applying these data using a simple pocket chart may assist decision about empirical omeprazole therapy in patients with dyspepsia in general practice.

Background: Most dyspeptic patients in primary care are managed without confirmatory investigations. In this study the reliability of the unaided clinical diagnosis and the diagnostic value of dyspepsia subgrouping are evaluated in unselected dyspeptic patients in primary care., Methods: Six hundred and twelve unselected dyspeptic patients were referred for interview and endoscopy. General practitioners stated a provisional diagnosis and a proposed management strategy. Before endoscopy, patients were classified on the basis of predominant symptoms as reflux-, ulcer-, or dysmotility-like or as unclassifiable, Results: The sensitivity and the positive predictive value of the diagnosis of ulcer were 0.58 and 0.29, respectively, and those for esophagitis 0.30 and 0.43. The predictive value of a clinical diagnosis of functional dyspepsia was high, but, considering the high prevalence of the condition, the chance-corrected validity was at the same level as for the other diagnoses (0.18-0.22). Classification of patients by predominant symptoms increased the a priori probability of ulcer and esophagitis in the respective subgroups. However, more than one-third of the patients with ulcer or esophagitis were classified in inappropriate subgroups., Conclusions: It is difficult to select an appropriate management strategy for dyspeptic patients on the basis of symptoms and history alone. Dyspepsia subgroups are of limited help in the decision process because of the low predictive value of the endoscopic diagnosis.

A five year follow-up study of a large random cohort was carried out with the aim of finding prevalence, incidence, prognosis and risk factors for upper dyspepsia according to different definitions. Fifty-four percent of the men and 47% of the women had experienced symptoms of upper dyspepsia within the past 12 months, while the prevalence of frequently occurring symptoms was 13% among men and 15% among women. Similarly the incidence was 22% among men and 25% among women, declining to 5% and 6% respectively when only frequent symptoms were considered. At five years follow-up approximately one quarter of the subjects with upper dyspepsia had recovered from all symptoms, while two thirds of the subjects who had experienced frequent symptoms did not do so any more. Psychological vulnerability increased the risk of having upper dyspepsia by 3.8, and risk of developing upper dyspepsia within five years 2.3. Different definitions identified different subjects as suffering from upper dyspepsia, and less than one quarter of the subjects fitted all the definitions.

In 1984 a random sample of a 70-year-old Danish population of 1119 subjects was questioned about abdominal symptoms and 5 years later survivors were contacted for follow-up. The participation rate at the primary study was 72% and 91% of the surviving subjects attended the follow-up. One-year period prevalences of single symptoms were 1-40%, annual incidence values 1-25% and 5-year disappearance rates were more than 50%. Irritable bowel syndrome occurred with a prevalence of 6-18% depending on definition, and incidences were of a similar magnitude. At the 5-year follow-up 50-79% of subjects originally suffering from irritable bowel syndrome no longer did so. The annual prevalence rate of symptoms of upper dyspepsia varied from 9% to 25%, annual incidence was 3-12%, and cumulative 5-year disappearance rate 45-65%. It is concluded that abdominal symptoms and the syndromes they constitute occur frequently and fluctuatingly in the elderly population.

The prevalence of pancreatic diseases as the cause for dyspepsia differs in clinical materials between 0 and 25-30%. In parallel, the incidence rate of chronic pancreatitis varies between 0.7 and 10 per 100,000 inhabitants per year. The correct figures are unsettled. The main reason for the great variability in figures for frequency of chronic pancreatitis is probably the different clinical awareness and variable practice for performing morphological and functional studies of the pancreas in patients with dyspepsia. Epidemiologic data indicate, but do not prove, an increasing frequency of chronic pancreatitis at least valid for the alcoholic chronic pancreatitis. Pancreatic function and pancreatic disease are probably connected to different gastro-intestinal diseases (duodenal ulcer, inflammatory bowel diseases, malabsorption syndromes, subtotal and total gastrectomy and to some extent in patients with hepatobiliary diseases). The prevalence of chronic pancreatitis can be calculated to around 70 per 100,000 inhabitants in the Western world. Around one-third of these present with exocrine pancreatic insufficiency. The demand for enzyme substitution based on marked exocrine pancreatic insufficiency in patients with chronic pancreatitis, pancreatic cancer and mucoviscidosis can be calculated to approximately 150 patients per 1 million inhabitants. The question concerning the analgetic effect of pancreatic enzyme substitution is still unsettled.