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Digestive Diseases and Sciences

, Volume 38, Issue 1, pp 147–154 | Cite as

What is behind dyspepsia?

  • Andreas G. Klauser
  • Winfried A. Voderholzer
  • Peter A. Knesewitsch
  • Norbert E. Schindlbeck
  • Stefan A. Müller-Lissner
Original Articles

Abstract

The first aim of the present study was to determine the cause of dyspepsia after negative conventional diagnostic work-up. In such patients, an extended diagnostic work-up was performed including esophageal pH monitoring and manometry, gastric and hepatobiliary scintigraphy, and lactose tolerance test. In 88 of 220 dyspeptic patients (mean age 49 years, range 17–87; 114 women) presenting to our gastroenterological outpatient department, a cause for dyspepsia was found by conventional work-up. Thirty-one of the remaining patients did not enter extended work-up, because of minor symptoms. In 47 of 101 patients entering extended work-up, a diagnosis was established (21 endoscopynegative gastroesophageal reflux disease, 11 gastric stasis, 6 biliary dyskinesia, and 5 lactase deficiency among them). A second aim of the study was to determine whether clusters of symptoms such as “gastroesophageal reflux-like”, “dysmotility-like”, and “dyspepsia of unknown origin” reliably predict the groups of diseases suggested by these terms. This was not the case. In conclusion, in 40% of dyspeptic patients, a conventional diagnostic work-up led to a diagnosis that explained a patient's symptoms. After a negative conventional diagnostic work-up, an extended diagnostic work-up with functional tests yielded a possible explanation for their symptoms in 47% of patients. In such patients symptomatology was of little help for predicting the diagnosis.

Key Words

dyspepsia diagnosis extended work-up symptomatology discriminant analysis 

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References

  1. 1.
    Colin-Jones DG, Bloom B, Bodenar G, Crean G, Freston J, Gugler R, Malagelada J, Nyren O, Petersen H, Piper D: Management of dyspepsia: Report of a working party. Lancet 1:576–579, 1988Google Scholar
  2. 2.
    Johns RJ, Fortuin NJ, Wheeler PS: The collection and evaluation of clinical information.In The Principles and Practice of Medicine 22nd ed. AM Harvey, RJ Johns, VA McKusick, AH Owens Jr, RS Ross (eds). Norwalk, Appleton & Lange, 1988, pp 4–21Google Scholar
  3. 3.
    Horrocks JC, De Dombal FT: Clinical presentation of patients “dyspepsia”. Detailed symptomatic study of 360 patients. Gut 19:19–26, 1978Google Scholar
  4. 4.
    Klauser AG, Schindlbeck NE, Müller-Lissner SA: Symptoms in gastro-oesophageal reflux disease. Lancet 335:205–208, 1990Google Scholar
  5. 5.
    Schindlbeck NE, Heinrich C, König A, Dehndorfer A, Pace F, Müller-Lissner SA: Optimal thresholds, sensitivity, and specificity of long-term pH-metry for the detection of gastroesophageal reflux disease. Gastroenterology 93:85–90, 1987Google Scholar
  6. 6.
    Richter JE, Wu WC, Johns DN, Blackwell JN, Nelson III JL, Castell JA, Castell DO: Esophageal manometry in 95 healthy adult volunteers. Variability of pressures with age and frequency of “abnormal” contractions. Dig Dis Sci 32:583–592, 1987Google Scholar
  7. 7.
    Dent J: Oesophageal manometry.In Gastrointestional Motility. Which Test? NW Read (ed). Petersfield, UK, Wrightson Biomedical Publishing Ltd, 1989, pp 27–40Google Scholar
  8. 8.
    Hope RA, Longmore JM, Moss PAH, Warrens AN: Oxford Handbook of Clinical Medicine, 2nd ed. 1989, pp 10–11Google Scholar
  9. 9.
    Sackett DL, Haynes RB, Guyatt GH, Tugwell P (eds). Clinical Epidemiology. A Basic Science for Clinical Medicine, 2nd ed. Boston, Little, Brown and Company 1991, pp 69–152Google Scholar
  10. 10.
    Lachenbruch PA: Discriminant Analysis. New York, Hafner Press, 1975Google Scholar
  11. 11.
    Wahl PW, Kronmal RA: Discriminant functions when covariances are unequal and sample sizes are moderate. Biometrics 33:479–484, 1977Google Scholar
  12. 12.
    Johannessen T, Petersen H, Kleveland PM, Dybdahl JH, Sandvik AK, Brenna E, Waldum H: The predictive value of history in dyspepsia. Scand J Gastroenterol 25:689–697, 1990Google Scholar
  13. 13.
    Krag E: Non-ulcer dyspepsia. Introductions: epidemiological data. Scand J Gastroenterol 17(suppl 79):6–7, 1982Google Scholar
  14. 14.
    Harvey RF, Salih SY, Read AE: Organic and functional disorders in 2000 gastroenterology outpatients. Lancet 1:632–634, 1983Google Scholar
  15. 15.
    Health and Public Policy Committee, American College of Physicians: Endoscopy in the evaluation of dyspepsia. Ann Intern Med 102:266–269, 1985Google Scholar
  16. 16.
    Shafer EA, Hershfield NB, Logan K, Kloiber R: Cholescintigraphic detection of functional obstruction of the sphincter of Oddi. Effect of papillotomy. Gastroenterology 90:728–733, 1986Google Scholar
  17. 17.
    Fullarton GM, Allan A, Hilditch T, Murray WR: Quantitative99mTc-DISIDA scanning and endoscopic biliary manometry in sphincter of Oddi dysfunction. Gut 29:1397–1401, 1988Google Scholar
  18. 18.
    Geenen JE, Hogan WJ, Dodds WJ, Toouli J, Venu RP: The efficacy of endoscopic sphincterotomy after cholecystectomy with sphincter of Oddi dysfunction. N Engl J Med 320:82–87, 1989Google Scholar
  19. 19.
    Joffé SN: Relevance of duodenitis to non-ulcer dyspepsia and peptic ulceration. Scand J Gastroenterol 17(suppl 79): 88–97, 1982Google Scholar
  20. 20.
    Elta GH, Murphy R, Behler EM, Barnett JL, Nostrant TT, Kern S, Appleman H:Campylobacter pylori in patients with dyspeptic symptoms and endoscopic evidence of erosion(s). Am J Gastroenterol 84:643–646, 1989Google Scholar
  21. 21.
    Marshall BJ: Should we now, routinely, be examining gastric biopsies forCampylobacters pylori? Gastric mucosal biopsy: An essential investigation in patients with dyspepsia. Am J Gastroenterol 83:479–481, 1988Google Scholar
  22. 22.
    Graham DY, Michaletz PA: Should I search forCampylobacter pylori in my patients? Much ado about not much? Am J Gastroenterol 83:481–483, 1988Google Scholar
  23. 23.
    McKinley AW, Upadhyay R, Gemmell CG, Russell RI:Helicobacter pylori: Bridging the credibility gap. Gut 31:940–945, 1990Google Scholar
  24. 24.
    Spiro HM: Moynihan's disease? The diagnosis of duodenal ulcer. N Engl J Med 291:567–569, 1974Google Scholar
  25. 25.
    Sackett DL, Haynes RB, Guyatt GH, Tugwell P (eds): Clinical Epidemiology. A Basic Science for Clinical Medicine, 2nd ed. Boston, Little, Brown and Company, 1991, pp 3–18Google Scholar
  26. 26.
    Sandler G: The importance of the history in the medical clinic and the cost of unnecessary tests. Am Heart J 100:928, 1980Google Scholar
  27. 27.
    Moriarty KJ, Dawson AM: Functionals abdominal pain. Further evidence the whole gut is affected. Br Med J 284:1670–1672, 1982Google Scholar
  28. 28.
    Whorwell PJ, McCallum M, Creed FH, Roberts CT: Noncolonic features of irritable bowel syndrome. Gut 27:37–40, 1986Google Scholar
  29. 29.
    Dotevall G, Svedlund J, Sjödin I. Symptoms in irritable bowell syndrome. Scand J Gastroenterol 17(suppl 79)16–19, 1982Google Scholar
  30. 30.
    Lindberg G, Seensalu R, Nilsson L-H, Forsell P, Kager L, Knill-Jones RP: Transferability of a computer system for medical history taking and decision support in dyspepsia. A comparison of indicants for peptic ulcer disease. Scand J Gastroenterol 22(suppl 128):86–89, 1987Google Scholar
  31. 31.
    Gotthard R, Bodemar G, Jönsson K-A: Diagnostic outcome in patients with dyspepsia. A preliminary report. Scand J Gastroenterol 22(suppl 128):68–89, 1987Google Scholar
  32. 32.
    Petersen H, Larsen S, Snavik L, Kleveland PM, Loge I, Sandbakken P, Hafstad PE, Kristensen P, Johannessen T, Fjosne U. Controlled trials in gastrodyspepsia: A methodological aspect. Scand J Gastroenterol 20(suppl 109):153–158, 1985Google Scholar

Copyright information

© Plenum Publishing Corporation 1993

Authors and Affiliations

  • Andreas G. Klauser
    • 1
    • 2
  • Winfried A. Voderholzer
    • 1
    • 2
  • Peter A. Knesewitsch
    • 1
    • 2
  • Norbert E. Schindlbeck
    • 1
    • 2
  • Stefan A. Müller-Lissner
    • 1
    • 2
  1. 1.Department of Gastroenterology, Klinikum Innenstadt, Medizinische KlinikUniversity of MunichMunich 2Germany
  2. 2.Department of Nuclear Medicine, Klinikum Innenstadt, Medizinische KlinikUniversity of MunichMunichGermany

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