Dyspepsia in primary care: a preliminary study about prevalence, diagnosis and prescriptive appropriateness.

BACKGROUND AND AIM . Functional dyspepsia (FD) is defined (Rome III) by the presence of epigastric pain or discomfort, and/or postprandial fullness within the last 3 months with symptom onset at least 6 months earlier in the absence of organic or systemic disease explaining them, and a negative upper endoscopy. Aim is to evaluate the prevalence of dyspepsia and FD in primary care to assess endoscopy (EGDS) and proton pump inhibitors (PPI) prescription appropriateness. METHODS . A 34-item anonymous dyspepsia-questionnaire (DQ) was administered to assess medical history, alarm symptoms, performed investigations and ongoing treatments. It was administered by 6 GPs for six months (May- October 2015) and included 260 patients (mean age 54 yrs; F/M: 143/117), aged > 18, who had never undergone abdominal surgery. The study population was divided into two groups according to the age (G1: 135 pts, 45yrs). RESULTS . 1. The dyspeptic patients were 71% of the total ones (60% female); 2. Each GP performed 20 visits/month (5% of total) for dyspepsia; 3. Only 3% in G1 and 30% in G2 of dyspeptic patients suffered from organic dyspepsia; 4. Among FD patients: 66% were thought to have GERD, even if diagnostic tests were negative, 41% suffered from anxious-depressive syndrome, 35 % smoked, and 42% were alcohol drinkers; 5. In G1, 49% of pts underwent EGDS (vs 50% in G2) despite the absence of alarm symptoms; 61% in G1 and 68% in G2 of FD patients received PPI therapy chronically and at high-doses; only 5% took prokinetic therapy. CONCLUSION. FD is a “real problem” in primary care and affects patient’s quality of life with a high socio-economic burden. The lifestyle correction is not seen essential  by patients that often prefer drugs for long periods and at high doses opening the chapter about PPI prescriptive appropriateness. Moreover, the high percentage of inappropriate EGDS performed in absence of alarm symptoms, reveals that FD patients have a high concern about their symptoms. We would need an integrated training program of GPs that, through a correct management of the demand, should increase interaction and collaboration with hospital specialists.