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Dyspeptic symptoms in primary care. An observational study in general practice

Maconi, Giovannia; Tosetti, Cesareb; Stanghellini, Vincenzoc; Bianchi Porro, Gabrielea; Corinaldesi, Robertoc

European Journal of Gastroenterology & Hepatology: September 2002 - Volume 14 - Issue 9 - p 985-990
Original Articles: Helicobacter pylori, dyspepsia

Background and aims  Dyspepsia frequently causes patients to consult a general practitioner, but is generally investigated in referral centres. This study describes features of dyspepsia and its relationship with demographic, clinical and socio-economic factors in patients seen by general practitioners in Italy.

Patients and methods  In Italy, 10 000 general practitioners were asked to recruit up to 10 consecutive dyspeptic patients during a 1-month period. Painful and non-painful dyspeptic symptoms, retrosternal pain/burning and visible abdominal distension were graded 0–3 by a validated questionnaire. Demographics and clinical features were also recorded.

Results  During the test period, 43 446 patients were included (55% were men; 50% were over 45 years old; 49% were smokers; 45% had experienced symptoms for ≥ 1 month; 28% had a history of peptic ulcer). Dyspepsia accounted for 8.3% (range 3–11%) of the consultations of a subset of participating doctors. Epigastric pain and fullness were reported in 84% and 79% of patients, respectively. Dyspeptic symptoms were moderate-severe (graded ≥ 2) in 69% of patients. Predominant epigastric pain and predominant discomfort were reported in 21% and 25% of the cases, respectively. Male gender, smoking, nocturnal awakening, overlapping reflux symptoms and a history of peptic ulcer were more frequent in patients with predominant pain, while female gender and overlapping abdominal distension were more common in patients with predominant discomfort. Age, educational level and working status were not related to any symptom pattern. Young patients presenting for the first time with uncomplicated dyspepsia accounted for 10% of the dyspepsia workload.

Conclusions  Dyspepsia accounts for a relevant workload for general practitioners. A considerable overlap exists among digestive symptoms. The proportion of patients that can be empirically treated according to current guidelines may be lower than expected.

aGastrointestinal Unit, L. Sacco University Hospital, Milan, bGeneral Practitioner, National Health System, Porretta Terme (Bologna) and cDepartment of Internal Medicine & Gastroenterology, University of Bologna, Bologna, Italy

Correspondence to Dr Giovanni Maconi, Gastrointestinal Unit, L. Sacco University Hospital, Via G.B. Grassi 74, 20157 Milan, Italy Tel: +39 02 39042486; fax: +39 02 39042232; e-mail:

Received 11 December 2001

Revised 12 March 2002

Accepted 17 May 2002

© 2002 Lippincott Williams & Wilkins, Inc.