Predicting endoscopic verified organic lesions in the dyspeptic patient: The predicative value of the General Practitioners clinical judgement

Aim: To assess the predicative value of clinical judgement of endoscopic diagnosis in the dyspeptic patients among General Practitioners (GPs) Methods: 32 general practices included 233 patients with dyspepsia without alarm symptoms. All patients had an endoscopy performed within 2 weeks. Dyspepsia definition: Epigastric pain/discomfort with/without symptom of reflux. The study was conducted in the County of Aarhus, Denmark. Outcome measures: The GPs clinical judgement of endoscopic diagnosis, endoscopic diagnosis. Results: According to the GPs clinical judgments 36% had functional dyspepsia, 24% had ulcer, 40% had reflux/oesophagitis and 0.4% had malignant disease. The endoscopy revealed that 74% had functional dyspepsia, 7% had ulcer, 18 % had oesophagitis and 1.3% had malignant disease. The predicative values of the GPs clinical judgement were 80 % (67/84) for functional dyspepsia, 11% (6/55) for ulcer, 25% (23/93) for oesophagitis, 0% (0/1) for malignant disease and 30% (44/149) for all organic lesions (ulcer, oesophagitis or malignancy). The sensitivity of the GPs clinical judgement was 39 % (67/172 for functional dyspepsia, 38% (6/16) for ulcer, 55% (23/42) for oesophagitis, 0% (0/3) for malignant disease and 72% (44/61) for all organic lesions. The GPs assessed organic lesion three times more common than revealed by endoscopy, but even then ¼ of the organic lesion was overlooked. Concerning reflux/oesophagitis both predicative value and sensitivity was even lower despite reflux should be the easiest organic dyspeptic lesion to asses clinical. Conclusion: Clinical judgement of endoscopic diagnosis in the dyspeptic patients by GPs does not satisfactorily predict endoscopic verified diagnosis. -- page break -- The General Practitioners clinical judgementEndoscopic diagnosisPredicative value of clinical judgementSensitivity of clinical judgementFunctional dyspepsia36 % (84)74 % (172)80 % (67/84)39 % (67/172)Ulcer24 % (55)7 % (16)11 % (6/55)38 % (6/16)Oesophagitis40 % (93)18 % (42)25 % (23/93)55 % (23/42)Malignancy0.4 (1)1.3 % (3)0 % (0/1)0 % (0/3)All organic lesion (ulcer, oesophagitis or malignancy)74% (149)26 % (61)30 % (44/149)72% (44/61) Endoscopic diagnosisFunctional dyspepsiaNo functional dyspepsia Clinical judgementFunctional dyspepsia6717No functional dyspepsia10544 Total17261 Endoscopic diagnosisUlcerNo ulcer Clinical judgementUlcer649No ulcer10168 Total16217 Endoscopic diagnosisOesophagitisNo oesophagitis Clinical judgementOesophagitis2370No oesophagitis19121 Total42191 Endoscopic diagnosisOrganic lesionNo organic lesion Clinical judgementOrganic lesion44105No organic lesion1767 Total61172