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Objectives: Most chronic and recurrent gastrointestinal (GI) symptoms in the community are caused by functional GI disorders, such as functional dyspepsia and irritable bowel syndrome (IBS). It is not known, however, whether these conditions affect mortality. We present the results of a large community-based prospective study that examines this issue., Methods: This was a 10-year follow-up, conducted in 2004, of individuals recruited into a community-based screening program for Helicobacter pylori. Data on mortality and cause of death at 10 years were obtained from the Office for National Statistics. Baseline demographic data, lifestyle factors, GI symptoms, and quality of life were recorded at study entry. The effect of all these factors on 10-year mortality was examined using univariate analysis and multivariate Cox regression analysis. All results were expressed as hazard ratios (HRs) with 99% confidence intervals (CIs)., Results: Symptom data were available for 8,323 (99.0%) of 8,407 individuals originally enrolled, comprising over 84,000 years of follow-up: 3,169 (38.1%) subjects had dyspepsia, and 264 (3.2%) IBS. There were 137 (1.65%) individuals who had died at 10 years. After multivariate analysis, there was no significant difference in likelihood of death at 10 years in those with dyspepsia (HR: 0.94; 99% CI: 0.58-1.54) or IBS (HR: 1.35; 99% CI: 0.36-5.10), compared with those not meeting the criteria for either condition., Conclusions: Dyspepsia was not associated with an increased mortality in the community. Data for any effect of IBS on survival were less clear. Further studies are required to assess the impact of functional GI disorders on life expectancy.

Background: Many individuals consulting their GP with upper abdominal symptoms are initially classified as having dyspepsia. Few studies have described the incidence of dyspepsia or the comorbidities, risk factors or prognosis associated with this diagnosis., Methods: We used the UK General Practice Research Database to find patients with a new diagnosis of dyspepsia in 1996 (n = 6,913) and a control cohort (n = 11,036). We determined the incidence of dyspepsia, potential risk factors and comorbidity, and the risk of new onset morbidity in the year following the index date., Results: The incidence of dyspepsia was 15.3 per 1,000 person-years. An increased probability of a dyspepsia diagnosis was associated with chest pain [odds ratio (OR): 2.4], general pain (OR: 1.8), sleep disorders (OR: 1.5), angina (OR: 1.5), osteoarthritis/rheumatoid arthritis (OR: 1.4) and smoking (OR: 1.2). There was only a borderline association with obesity (OR: 1.1). Patients with dyspepsia had an increased likelihood of a diagnosis of irritable bowel syndrome (IBS) (OR: 264), gastroesophageal reflux disease (GERD) (OR: 62.8) or peptic ulcer disease (PUD) (OR: 27.2) during the following year., Conclusions: The commonest diagnosis to emerge after an initial consultation for dyspepsia was IBS, followed by GERD and PUD.

Introduction: The objective of the study was to determine the effectiveness of endoscopy to detect curable upper gastrointestinal malignancy in patients older than 55 years presenting with uncomplicated dyspepsia., Methods: A cohort study was performed in North Glasgow Health Trust. One hundred and thirty-one patients older than 55 years of age, diagnosed to have upper gastrointestinal cancer within the North Glasgow Trust between January 1995 and December 1997, identified by the West of Scotland Cancer Registry were included. The main outcome measures were the proportion of upper gastrointestinal cancers that present in patients older than 55 years with uncomplicated dyspepsia, and the proportion of patients that presented with uncomplicated dyspepsia who have curable upper gastrointestinal cancer., Results: Of the 131 cancer cases identified, only 30 (23%) had dyspepsia (complicated or uncomplicated) as their predominant symptom and only eight (6%) patients presented with uncomplicated dyspepsia. Of those eight patients presenting with uncomplicated dyspepsia and found to have upper gastrointestinal cancer, six were found to have lymph node metastases and/or extensive metastases at the time of diagnosis. Each of these six patients died from their cancer within 39 months of diagnosis. Of the two patients presenting with uncomplicated dyspepsia without evidence of lymph node spread, one died 55 days after diagnosis. Only one patient presenting with uncomplicated dyspepsia and found to have cancer remains alive at 5-year follow-up., Conclusions: Of the 131 patients diagnosed with upper gastrointestinal cancer, only eight presented with uncomplicated dyspepsia and only one of these was cured. Consequently a policy of endoscoping patients older than 55 years with uncomplicated dyspepsia will reduce death from upper gastrointestinal cancers by less than 1% in our population.

Background: Ten percent of patients consulting a general practitioner (GP) because of dyspepsia report one or more alarm symptom(s): anemia, black stools, blood in stools, dysphagia, jaundice, weight loss. We observed the consequence of such symptoms prospectively over 3 years., Methods: Postal questionnaires were sent to GPs to obtain recorded information from patients who had consulted the GP because of dyspepsia. Mortality and gastrointestinal morbidity per 1000 person years were studied in two cohorts of patients, one presenting with, the other without, alarm symptoms and compared to expected rates from the general population. The incidence of ulcers was compared between the two cohorts. The predictive value of alarm symptoms for the development of cancer and ulcer was calculated., Results: Compared to the general population, dyspeptic patients without alarm symptoms had an insignificant increase in mortality (OR = 1.5 (0.9-2.4)) and a significant increase in gastrointestinal (GI) cancers (OR = 2.4 (1.1-7.1)), whereas in patients with alarm symptoms both mortality (OR = 2.3 (1.7-3.2)) and GI cancers (OR = 6.3 (3.6-11.0)) were significantly raised. In dyspeptic patients, the presence of alarm symptoms increased the risk of developing peptic ulcers significantly (OR = 5.3 (3.1-9.1)) and gastrointestinal cancer insignificantly (OR = 1.9 (0.9-4.1)). Positive predictive values for development of cancer and ulcer were 4% and 14%, respectively. During 3 years of observation, patients with alarm symptoms were diagnosed with a malignancy in 4%, ulcers in 11% and minor gastrointestinal diseases in 25% of cases., Conclusion: Although the presence of alarm symptoms predicts a bad prognosis, the positive predictive values were low and negative predicted values high, reflecting low incidences of the diseases in the population at risk. The majority of patients who developed cancer or ulcer did not present with alarm symptom(s) at the initial consultation.

Dyspepsia, and the issue of Helicobacter pylori status, can present significant controversies in clinical management. Both primary physicians and gastroenterologists should be aware of options for the treatment of patients with dyspepsia. This article reviews information gathered about the eradication of H. pylori in non-ulcer dyspepsia (NUD), therapy for NUD not associated with H. pylori, and whether H. pylori testing should replace routine endoscopy in uncomplicated dyspepsia. The benefits of eradicating H. pylori in NUD include superior, cost-effective resolution of symptoms, compared to placebo; reduction of ulcer and gastric cancer risk; and removal of risk of certain adverse effects should long-term proton pump inhibitor therapy become necessary. In patients with normal endoscopy and no evidence of H. pylori, proton pump inhibitor therapy is superior to placebo in controlling symptoms. This benefit is confined to patients with symptoms and/or oesophageal pH-metry indicative of GORD. Non-invasive H. pylori testing may be appropriate for younger dyspeptic patients with no alarm symptoms who are not taking non-steroidal anti-inflammatory drugs (NSAIDs). In conclusion, eradication of H. pylori is advisable in patients with NUD. Proton pump inhibitor therapy is superior to placebo in NUD patients without H. pylori, especially if symptoms indicate GORD. H. pylori testing may replace endoscopy in young dyspeptics with no alarm symptoms or NSAID use.

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.