ISSN:
1365-2036
Source:
Blackwell Publishing Journal Backfiles 1879-2005
Topics:
Medicine
Notes:
Patients presenting with dyspepsia and heartburn are a heterogeneous group and a more precise identification of the cause of the symptoms is a prerequisite for a rational treatment. The patient's history is the basic diagnostic tool. Therefore it is important to evaluate the utility of symptoms as a predictor of any organic disease, like peptic ulcer, or as a predictor of a favourable symptomatic response to a specific drug treatment, such as omeprazole. When the history alone was used to discriminate between peptic ulcer and non-ulcer dyspepsia half of the patients with endoscopically-confirmed active ulcer were misdiagnosed as not having ulcers. Furthermore, in two-thirds of the patients in whom a clinical diagnosis of peptic ulcer was made, this was not confirmed at endoscopy. Heartburn is recognized as a symptom of reflux oesophagitis, but most patients complaining of heartburn have no visible mucosal lesion at endoscopy. The predictive value of heartburn depends on its severity; one-half of patients with severe heartburn, in fact, have oesophagitis. When symptoms of reflux oesophagitis are used in a scoring system, the diagnostic sensitivity is about 50% while the specificity is 34–85%, depending on the severity of symptoms. When a complete patient history is used as a predictor, the diagnostic value increases significantly. Patients with endoscopy-negative dyspepsia and heartburn are a common problem and acid inhibitory drugs are widely used to manage the disease. The rationale for prescribing an acid inhibitor in this situation is the assumption that the symptoms are acid-related, but this is only the case for a subgroup of these patients. Identification of those patients who have acid-related symptoms is possible using omeprazole as a diagnostic tool, either in an open design or in a placebo-controlled single-subject trial. When heartburn is a predominant symptom, 50% of the patients respond to the acid inhibitory treatment, while this is the case for only one-third of patients when heartburn is not the dominating symptom. It is important to identify symptoms that, when present, significantly reduce the likelihood of a specific diagnosis or condition. This is the case with the symptom of loose stools in patients with dyspepsia, where it reduces the likelihood of a symptomatic improvement during treatment with omeprazole. In conclusion, symptoms do not reliably predict the underlying disorder, whether this is an organic disease or endoscopy-negative dyspepsia. Clusters of symptoms or the more global clinical judgement seem to have a higher discriminative value compared with a single symptom.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1111/j.1365-2036.1997.tb00787.x
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