Appropriateness of indications for Diagnostic Upper Gastrointestinal Endoscopy and proposing guidelines for evaluation of Dyspepsia.

Sumathi, B (2006) Appropriateness of indications for Diagnostic Upper Gastrointestinal Endoscopy and proposing guidelines for evaluation of Dyspepsia. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION : The term dyspepsia is used variably by health professionals to refer to a heterogeneous group of upper abdominal symptoms that may arise from numerous causes. Patients seldom use the term dyspepsia and describe their abdominal symptoms instead in terms of discomfort, pain, bloating, fullness, burning, or indigestion. The way a patient perceives and reports these symptoms is dependent upon a complex interplay of biologic variables, personality traits, social support mechanisms, coping strategies, culture and language. Dyspepsia is a common symptom in the community and more than one third experience the problem of indigestion in 6 months. Gastrointestinal (GI) disorders account for about 10% of all consultation with general practitioner and about half of them have dyspepsia. Despite the substantial decline in the prevalence of peptic ulceration over the past 20 years, the incidence of dyspepsia has remained constant. It poses a diagnostic & therapeutic challenge to the clinician. During the past two decades, the number of upper gastrointestinal endoscopy (UGIE) being performed has increased. This has resulted in long waiting list in many centers. The introduction of increasingly complex technologies in health sector makes it necessary to evaluate the procedures not only in terms of efficacy and cost, but also with regards to the appropriation of the procedure in clinical setting. BACKGROUND : The British society has laid guidelines for an early endoscopy in dyspeptic patients with alarm symptoms and for those above the age of 45. Open access endoscopy is being currently resulting in high workload in endoscopy suite. There are no standard guidelines for performing UGI endoscopy in our population. This prospective study was done to have a guideline based on the outcome of endoscopy in patients with dyspepsia namely ulcer (ULD), reflux (RLD), dysmotility (DD) either alone or in combination (CTD), with or without alarm symptoms and alarm symptoms alone. Patients attending outpatient department of Medical Gastroenterology with dyspepsia were subjected for UGI endoscopy, after a thorough clinical examination and recording of clinical details in a structured proforma. AIM OF THE STUDY ; To determine the outcome of endoscopy among dyspeptics with and without alarm symptoms. To determine the outcome of alarm symptoms on endoscopy. To identify the cut off age for an early endoscopy amongst dyspepsia with no alarm symptoms. Appropriateness of indications for diagnostic UGI endoscopy in association with relevant endoscopic disease. CONCLUSION : Indication for endoscopy needs to be tailored according to the clinical presentation in dyspepsia. Individuals below the age of 35, in the absence of alarm symptoms can be managed with an empirical anti peptic therapy and reviewed at the end of 4 weeks. Persistence of symptoms should warrant an early endoscopy. Those with alarm symptoms require an endoscopy within one week. A normal endoscopy in dyspepsia cannot be readily dismissed as irrelevant. Reassurance provided by normal findings may subsequently result in fewer symptoms, avoidance of unnecessary treatment and decreased consultation rate. For the future, the current guidelines laid down in this study needs extrapolation and prospective validation in different regions of the country.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Appropriateness ; indications ; Diagnostic Upper Gastrointestinal Endoscopy ; Dyspepsia.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 13 Jul 2017 04:14
Last Modified: 13 Jul 2017 04:14

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