Backgroundand aim. Although the optimal approach toGERDand dyspepsia remains controversial, guidelines recommend initial therapy, reserving additional intervention for relapser and non-responder patients. However, spontaneous physician attitude can affect guidelines applicability to GERD and dyspepsia, which are mainly approached by general practitioners (GPs). To evaluate the divergence among GPs in Italy between proposed and real clinical approach to na¨ıve or relapser patients withGERDor dyspeptic symptoms. Material and methods. The study was designed to have two steps. First, we questioned 259 GPs on their therapeutic or diagnostic approach to na¨ıve and relapser patients with symptoms of GERD (heartburn, regurgitation) or dyspepsia (epigastric burning/pain, post-prandial fullness, early satiety, upper bloating and nausea). Based on the prevalent symptoms, dyspepsia was further classified as ulcer-like (UL), dysmotility-like (DML) and unspecified (US). In the second phase, at least 1 month later, all GPs were asked to collect information on all the patients with GERD or dyspeptic symptoms they had visited during the last 20 days. Specifically, GPs collected information on clinical symptom pattern (GERD, UL, DML and/or US), admission time (na¨ıve or relapser patient) and therapeutic or diagnostic approach. Only patients with a pure clinical pattern of GERD or dyspepsia were selected. The statistical analysis was performed by χ2-test. Results. The 259 GPs screened 2030 patients, selecting only the 1035 with a pure clinical pattern. Based on their clinical pattern, the distribution of the patients was the following: 335 GERD, (naive patients: 225); 353 UL (248), 191 DML (144) and 156 US (115). The proposed or real clinical approaches are summarised in the table. A significant divergence (p < 0.01) between the proposed and the real clinical approachwas observed for all situations except than for na¨ıve patient with US. Conclusions. In this study, we observed that the substantial opinion of GPs on how to treat na¨ıve patients with GERD or dyspepsia was not confirmed in clinical practice, except for unspecified dyspepsia. Conversely, a diagnostic approach to relapser patients was the prevalent choice in the GPs opinion, although a therapeutic approach prevailed in clinical practice. This study confirms the demand of a careful verification of the management of GERD and dyspepsia in primary care practice.

Test or treat in gerd and dyspepsia: what general practitioners would do and what they really do

CUOMO, ROSARIO;D. Bruzzese;SARNELLI, GIOVANNI;E. Menditto;BUDILLON, GABRIELE;
2005

Abstract

Backgroundand aim. Although the optimal approach toGERDand dyspepsia remains controversial, guidelines recommend initial therapy, reserving additional intervention for relapser and non-responder patients. However, spontaneous physician attitude can affect guidelines applicability to GERD and dyspepsia, which are mainly approached by general practitioners (GPs). To evaluate the divergence among GPs in Italy between proposed and real clinical approach to na¨ıve or relapser patients withGERDor dyspeptic symptoms. Material and methods. The study was designed to have two steps. First, we questioned 259 GPs on their therapeutic or diagnostic approach to na¨ıve and relapser patients with symptoms of GERD (heartburn, regurgitation) or dyspepsia (epigastric burning/pain, post-prandial fullness, early satiety, upper bloating and nausea). Based on the prevalent symptoms, dyspepsia was further classified as ulcer-like (UL), dysmotility-like (DML) and unspecified (US). In the second phase, at least 1 month later, all GPs were asked to collect information on all the patients with GERD or dyspeptic symptoms they had visited during the last 20 days. Specifically, GPs collected information on clinical symptom pattern (GERD, UL, DML and/or US), admission time (na¨ıve or relapser patient) and therapeutic or diagnostic approach. Only patients with a pure clinical pattern of GERD or dyspepsia were selected. The statistical analysis was performed by χ2-test. Results. The 259 GPs screened 2030 patients, selecting only the 1035 with a pure clinical pattern. Based on their clinical pattern, the distribution of the patients was the following: 335 GERD, (naive patients: 225); 353 UL (248), 191 DML (144) and 156 US (115). The proposed or real clinical approaches are summarised in the table. A significant divergence (p < 0.01) between the proposed and the real clinical approachwas observed for all situations except than for na¨ıve patient with US. Conclusions. In this study, we observed that the substantial opinion of GPs on how to treat na¨ıve patients with GERD or dyspepsia was not confirmed in clinical practice, except for unspecified dyspepsia. Conversely, a diagnostic approach to relapser patients was the prevalent choice in the GPs opinion, although a therapeutic approach prevailed in clinical practice. This study confirms the demand of a careful verification of the management of GERD and dyspepsia in primary care practice.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11588/361375
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