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Diagnostic methods in dyspepsia: the usefulness of upper abdominal ultrasound and gastroscopy
M T Heikkinen1, P H Pikkarainen, J K Takala
1Department of Internal Medicine, Kuopio University Hospital, Finland.
Objectives:
To examine the diagnostic value of gastroscopy and upper abdominal ultrasound, which are frequently used as primary tests in dyspeptic patients in general practice. To test the influence of age for accuracy of both diagnostic methods.
Design:
Clinical study.
Setting:
Four health centres in Kuopio Province, Finland.
Subjects:
Four hundred unselected consecutive dyspeptic patients (91 less than 45 years of age) who consulted their general practitioners.
Main Outcome Measures:
Sensitivity, specificity, positive and negative predictive values (PV), efficiency and usefulness index (UI) were calculated for upper abdominal ultrasound and for gastroscopy in detecting the causes of dyspepsia in primary care. Final diagnosis was determined after one year follow-up.
Results:
The sensitivity of upper abdominal ultrasound in detecting the cause of dyspepsia was 0.07, the specificity 0.91, PV+ 0.36, PV- 0.56, and UI -0.001. Ultrasound was not more efficient in older patients. Gastroscopy was the most efficient method with a sensitivity of 0.75, specificity 1.00, PV+ 0.99, PV- 0.83 and UI 0.56. The usefulness of gastroscopy was even better among patients over 45 years of age.
Conclusions:
The usefulness of upper abdominal ultrasound is low regardless of patient's age. Gastroscopy is superior to upper abdominal ultrasound as a first line diagnostic method in diagnosing dyspepsia, especially among patients over 45 years of age.