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What is behind dyspepsia?

Digestive Diseases and Sciences volume 38, pages 147–154 (1993)Cite this article

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.

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References

  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, 1988

    Google Scholar 

  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 4–21

    Google Scholar 

  3. Horrocks JC, De Dombal FT: Clinical presentation of patients “dyspepsia”. Detailed symptomatic study of 360 patients. Gut 19:19–26, 1978

    Google Scholar 

  4. Klauser AG, Schindlbeck NE, Müller-Lissner SA: Symptoms in gastro-oesophageal reflux disease. Lancet 335:205–208, 1990

    Google Scholar 

  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, 1987

    Google Scholar 

  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, 1987

    Google Scholar 

  7. Dent J: Oesophageal manometry.In Gastrointestional Motility. Which Test? NW Read (ed). Petersfield, UK, Wrightson Biomedical Publishing Ltd, 1989, pp 27–40

    Google Scholar 

  8. Hope RA, Longmore JM, Moss PAH, Warrens AN: Oxford Handbook of Clinical Medicine, 2nd ed. 1989, pp 10–11

  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 69–152

    Google Scholar 

  10. Lachenbruch PA: Discriminant Analysis. New York, Hafner Press, 1975

    Google Scholar 

  11. Wahl PW, Kronmal RA: Discriminant functions when covariances are unequal and sample sizes are moderate. Biometrics 33:479–484, 1977

    Google Scholar 

  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, 1990

    Google Scholar 

  13. Krag E: Non-ulcer dyspepsia. Introductions: epidemiological data. Scand J Gastroenterol 17(suppl 79):6–7, 1982

    Google Scholar 

  14. Harvey RF, Salih SY, Read AE: Organic and functional disorders in 2000 gastroenterology outpatients. Lancet 1:632–634, 1983

    Google Scholar 

  15. Health and Public Policy Committee, American College of Physicians: Endoscopy in the evaluation of dyspepsia. Ann Intern Med 102:266–269, 1985

    Google Scholar 

  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, 1986

    Google Scholar 

  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, 1988

    Google Scholar 

  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, 1989

    Google Scholar 

  19. Joffé SN: Relevance of duodenitis to non-ulcer dyspepsia and peptic ulceration. Scand J Gastroenterol 17(suppl 79): 88–97, 1982

    Google Scholar 

  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, 1989

    Google Scholar 

  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, 1988

    Google Scholar 

  22. Graham DY, Michaletz PA: Should I search forCampylobacter pylori in my patients? Much ado about not much? Am J Gastroenterol 83:481–483, 1988

    Google Scholar 

  23. McKinley AW, Upadhyay R, Gemmell CG, Russell RI:Helicobacter pylori: Bridging the credibility gap. Gut 31:940–945, 1990

    Google Scholar 

  24. Spiro HM: Moynihan's disease? The diagnosis of duodenal ulcer. N Engl J Med 291:567–569, 1974

    Google Scholar 

  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 3–18

    Google Scholar 

  26. Sandler G: The importance of the history in the medical clinic and the cost of unnecessary tests. Am Heart J 100:928, 1980

    Google Scholar 

  27. Moriarty KJ, Dawson AM: Functionals abdominal pain. Further evidence the whole gut is affected. Br Med J 284:1670–1672, 1982

    Google Scholar 

  28. Whorwell PJ, McCallum M, Creed FH, Roberts CT: Noncolonic features of irritable bowel syndrome. Gut 27:37–40, 1986

    Google Scholar 

  29. Dotevall G, Svedlund J, Sjödin I. Symptoms in irritable bowell syndrome. Scand J Gastroenterol 17(suppl 79)16–19, 1982

    Google Scholar 

  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, 1987

    Google Scholar 

  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, 1987

    Google Scholar 

  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, 1985

    Google Scholar 

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Affiliations

  1. Department of Gastroenterology, Klinikum Innenstadt, Medizinische Klinik, University of Munich, Ziemssenstr. 1, D-8000, Munich 2, Germany

    Andreas G. Klauser MD, Winfried A. Voderholzer MD, Peter A. Knesewitsch MD, Norbert E. Schindlbeck MD & Stefan A. Müller-Lissner MD

  2. Department of Nuclear Medicine, Klinikum Innenstadt, Medizinische Klinik, University of Munich, Munich, Germany

    Andreas G. Klauser MD, Winfried A. Voderholzer MD, Peter A. Knesewitsch MD, Norbert E. Schindlbeck MD & Stefan A. Müller-Lissner MD

Authors
  1. Andreas G. Klauser MD
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  2. Winfried A. Voderholzer MD
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  3. Peter A. Knesewitsch MD
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  4. Norbert E. Schindlbeck MD
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  5. Stefan A. Müller-Lissner MD
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Klauser, A.G., Voderholzer, W.A., Knesewitsch, P.A. et al. What is behind dyspepsia?. Digest Dis Sci 38, 147–154 (1993). https://doi.org/10.1007/BF01296788

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  • DOI: https://doi.org/10.1007/BF01296788

Key Words

  • dyspepsia
  • diagnosis
  • extended work-up
  • symptomatology
  • discriminant analysis