[Dyspepsia in general medicine: current diagnostic approach]

Area of Science:

• Gastroenterology
• Internal Medicine
• Diagnostic Endoscopy

Background:

• Upper gastrointestinal (GI) endoscopy is a primary tool for dyspepsia investigation.
• Non-invasive Helicobacter pylori (Hp) detection and early acid-suppressing drug use challenge traditional endoscopy indications.
• Revisiting endoscopy guidelines is necessary given evolving diagnostic and treatment paradigms.

Purpose of the Study:

• To re-evaluate and refine the indications for upper GI endoscopy in patients presenting with dyspepsia.
• To establish a clear decision-making framework for endoscopy based on patient history, symptoms, and risk factors.

Main Methods:

• Analysis of patient medical history, including personal and familial antecedents (e.g., gastric cancer).
• Categorization of dyspeptic patients into symptomatic groups: alarm symptoms, typical ulcer pain, gastro-oesophageal reflux disease (GORD), and non-specific dyspepsia.
• Application of age-specific and risk-stratified criteria for recommending endoscopy versus non-invasive testing.

Main Results:

• Immediate endoscopy is recommended for alarm symptoms or typical ulcer pain, barring uncomplicated duodenal ulcer relapse.
• For GORD, endoscopy is generally not required in patients under 45.
• Non-specific dyspepsia in patients under 45 may initially benefit from non-invasive Hp testing ('test and scope').
• Endoscopy with biopsies is the preferred initial investigation for patients over 45, or those with a personal history of gastric ulcer, or familial gastric cancer.

Conclusions:

• Accurate patient assessment, including detailed history and symptom classification, is paramount for appropriate endoscopy referral.
• A tailored approach balancing endoscopy with non-invasive testing optimizes resource utilization and patient management in dyspepsia.
• Age and specific risk factors significantly influence the decision-making process for upper GI endoscopy.