RESUMO
OBJECTIVE: To prospectively assess the accuracy of a scoring system to predict organic diseases in dyspeptic patients in an area of South Europe, and to compare it with that of Helicobacter pylori testing in patients with dyspepsia in an environment with high prevalence of H. pylori infection. METHODS: Symptoms and demographic data were recorded in 501 consecutive dyspeptic patients referred to an outpatient gastroenterology clinic. A simple scoring system was constructed from the predictive factors obtained in a multi-variate logistic regression analysis. Overall predictive accuracy was assessed with the c statistic. The model was validated using bootstrap techniques. The accuracy of clinical judgement and H. pylori testing to predict endoscopic diagnosis was also assessed. RESULTS: Organic dyspepsia (peptic ulcer, oesophagitis or malignancies) was diagnosed in 45% of the patients. The test for H. pylori was positive in 68%, and 29% of infected patients had an ulcer. The organic dyspepsia predictive model had an accuracy of 0.79, which decreased to 0.77 after validation adjustment. The predictive accuracies for clinical judgement and H. pylori testing were 0.69 and 0.61, respectively. The addition of H. pylori testing to the scoring system resulted in a minor improvement of the predictive accuracy. CONCLUSION: In an environment with a high rate of H. pylori infection and a low prevalence of peptic ulcer among infected patients, a scoring system has higher predictive accuracy for the diagnosis of organic disease than H. pylori testing. Moreover, in this setting, H. pylori testing adds a minimum value to the predictive capability of the scoring system.
Assuntos
Dispepsia/diagnóstico , Esofagite/diagnóstico , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/epidemiologia , Helicobacter pylori/isolamento & purificação , Úlcera Gástrica/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Diagnóstico Diferencial , Dispepsia/epidemiologia , Dispepsia/microbiologia , Esofagite/epidemiologia , Esofagite/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Probabilidade , Estudos Prospectivos , Medição de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Úlcera Gástrica/epidemiologia , Úlcera Gástrica/microbiologiaAssuntos
Osteomielite/microbiologia , Infecções Estafilocócicas , Adulto , Humanos , Masculino , Fatores de TempoRESUMO
A 76-yr-old man developed necrotizing fasciitis due to Salmonella enteritidis 1 month after an episode of gastroenteritis due to the same microorganism. The fact that S. enteritidis was the only organism isolated despite adequate anaerobic cultures confirm the ability of salmonellae to produce severe monomicrobial soft tissue infections.