Reassessing the value of gastroscopy for the investigation of dyspepsia.

ABSTRACT

OBJECTIVE: To evaluate the diagnostic yield of investigating dyspepsia with oesophagogastroduodenoscopy (OGD) with or without mucosal biopsy. DESIGN: Retrospective service evaluation study. SETTING: Two teaching hospitals The Royal Hallamshire Hospital and Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, UK. PATIENTS 500 patients, 55 years of age and over, who underwent OGD to investigate dyspepsia were included. The study period included a 3-month window. All OGDs were performed on an outpatient basis. INTERVENTIONS: Data were extracted from electronic OGD records within the study period. MAIN OUTCOME MEASURES: Diagnostic yield provided by endoscopic examination and histological assessment. RESULTS: 378 patients (75.6%) were reported to have some form of endoscopic abnormality, and 417 patients (83.4%) had biopsies taken. The most common findings at OGD were gastritis (47.2%) and oesophagitis (24.4%). Oesophagogastric malignancy was seen in 1%. Diagnoses made endoscopically or histologically that would not have been appropriately managed by empirical therapies were seen in 16.2%. CONCLUSION: OGD in dyspepsia influences patient management in approximately one-sixth of cases. However, the majority of patients are sufficiently managed with Helicobacter pylori testing and eradication and/or a trial of proton pump inhibitor therapy. Further non-invasive approaches are needed to identify patients who need endoscopy for biopsy or therapy.