Discriminant value of dyspeptic symptoms: a study of the clinical presentation of 221 patients with dyspepsia of unknown cause, peptic ulceration, and cholelithiasis.

Talley, Nicholas; McNeil, Don; Piper, D. W.

doi:10.1136/gut.28.1.40

Cited by 83 publications

(37 citation statements)

References 20 publications

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“…2 In part, these contradictory findings are related to differences in research design. Some studies are uncontrolled, [13][14][15] other reports present findings from patients seeking medical care, [16][17][18] from case-control studies, 15,[19][20][21] or from community-based studies on selected [22][23][24][25][26][27] or unselected [28][29][30][31] populations. A recent meta-analysis, which takes into account all the studies issued on this topic from 1983 to 1992, concludes that only upper abdominal pain (with no preference for the right side)…”

Section: Discussionmentioning

confidence: 99%

Clinical manifestations of gallstone disease: Evidence from the multicenter Italian study on cholelithiasis (MICOL)

et al. 1999

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Despite the many efforts to delineate the clinical manifestations of gallbladder disease, the precise symptom complex associated with gallstones is still a matter of debate, and even the existence of gallstone-specific symptoms has been questioned. We carried out a large population-based cross-sectional study (MICOL) to identify symptoms significantly related to gallstones. Fourteen centers throughout Italy enrolled 29,504 subjects aged 30 to 69 years. All subjects were administered an ultrasonographic examination of the upper abdomen and a precoded questionnaire. All subjects were divided into 4 groups: 25,374 (86.0%) gallstone-free subjects (GF), 1,832 (6.2%) patients with gallstones not previously diagnosed (GNPD), 638 (2.2%) patients with gallstones previously diagnosed (GPD), 1,660 (5.6%) patients with a history of cholecystectomy for gallstones (CC). In logistic regression analysis, pain at epigastrium and, even more, pain at right hypocondrium were significantly associated with gallstones. For pain at right hypocondrium, this association progressively increased from GNPD (OR ‫؍‬ 1.60, 95% CI ‫؍‬ 0.97-2.65) to GPD (OR ‫؍‬ 8.77, 95% CI ‫؍‬ 5.27-14.61) to CC (OR ‫؍‬ 59.40, 95% CI ‫؍‬ 43.87-80.42). Absence of heartburn combined with right hypocondrium or epigastrium pain and intolerance to fried or fatty food were also significantly related to gallstones. We also found some pain characteristics significantly associated with gallstones, i.e., pain radiated to the right shoulder, forcing the patient to rest, occurring soon after meals or unrelated to meals, not relieved by bowel movements, and frequently accompanied by gallstonerelated morbidities. We developed a probability tree reporting the cumulative probability of having gallstones for each combination of those symptoms and characteristics of pain significantly associated with gallstones. In conclusion, we have identified symptoms and signs significantly associated with gallstones. We have shown that there is an increase in frequency and severity of these symptoms and signs across the different stages of gallstone disease. We have proposed a complex of symptoms and signs significantly associated with gallstones that might help physicians in clinical decision making. (HEPATOLOGY 1999;30:839-846.)Despite the many efforts to delineate the clinical manifestations of gallbladder disease, the precise symptom complex associated with gallstones is still a matter of debate, and even the existence of gallstone-specific symptoms has been questioned. 1-3 Most of the attention has been focused on pain in gallstone patients, but there is no general agreement on its clinical meaning 3 and it is questioned whether pain occurs in gallstone disease with specific characteristics. 1,2 The identification of symptoms associated with this disease might help physicians in clinical decision making. [4][5][6][7] Moreover, the possibility of identifying patients who are more likely to have gallstones through a clinical assessment would limit the excessive and inappropriate use of di...

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Section: Discussionmentioning

confidence: 99%

Clinical manifestations of gallstone disease: Evidence from the multicenter Italian study on cholelithiasis (MICOL)

et al. 1999

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“…Therefore, it is crucial to know how GPs actually manage dyspepsia. Previous studies concerning the reliability of the working diagnosis based solely on clinical history and physical finding have been affected by selection bias, or the study patients have been investigated and followed up incompletely (6)(7)(8)(9)(10). In our study, we sought to avoid these methodological weaknesses by investigating 400 unselected consecutive dyspeptic patients in primary care.…”

Section: Discussionmentioning

confidence: 99%

“…Most studies concerning the discriminant value of the patient's medical history and dyspepsia have been done on patients already referred to gastroscopy (6)(7)(8)(9)(10). In ''real life'', the ability of GPs to diagnose the causes of dyspepsia based on their clinical examination has been poorly investigated.…”

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confidence: 99%

GPs' ability to diagnose dyspepsia based only on physical examination and patient history

Heikkinen

Pikkarainen²,

Eskelinen³

et al. 2000

Scandinavian Journal of Primary Health Care

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“…The Rome III criteria were updated to identify a more homogeneous patient group for pathophysiological studies and clinical trials [4,5]. There have been some changes to the definitions of FGIDs according to the ROME III criteria [5,6].…”

Section: Introductionmentioning

confidence: 99%

“…Most gastrointestinal (GI) disorders are diagnosed from a physiological abnormality or biomarker, and no defintive pathophysiological features characterize FGIDs [2,3]. Therefore, it is necessary to exclude other diseases before a functional GI designation can be made [4].…”

Section: Introductionmentioning

confidence: 99%

Reliability and Validity of Korean Bowel Disease Questionnaire for Functional Gastrointestinal Disorders

Song

Jung

2011

Ewha Med J

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Objectives:The Korean version of Bowel disease questionnaire (BDQ-K) was developed to evaluate the symptom items required to meet the definition of functional gastrointestinal disorders (FGIDs). We evaluated the test-retest reliability and validity of the self-reported BDQ-K and prevalence of functional dyspepsia (FD) and irritable bowel syndrome (IBS) according to the Rome-III criteria. Methods: Sixty-nine patients participated in the test-retest reliability study, with a two week interval, and another 74 patients were enrolled to assess the self-reported questionnaire versus a doctor's interview (concurrent validity). A total of 3,325 subjects (mean age, 44±9 yrs; 58.3% male) presenting for an upper endoscopy responded to the BDQ-K at a health promotion center, but 797 subjects with organic diseases were excluded. Results: In the validity study of the BDQ-K, the median kappa value was 0.74 (0.36∼1.0). The median kappa value for the test-retest was 0.56 (range 0.22∼1.0), including abdominal pain (κ=0.51, P＜0.001), pain onset before 6 months (κ=0.51, P＜0.001), epigastric pain (κ=0.69, P＜0.001), early satiety (κ=0.40, P＜0.001), and postprandial fullness (κ=0.34, P＜0.001). The prevalence of FD was 8.3% (209/2,528); epigastric pain more than once a week 4.4%, early satiety 2.5%, and postprandial fullness 6.1%. FD was more prevalent in women (P=0.001). The prevalence of IBS was 6.1% and IBS also predominated in women (7.1% vs 5.1% in men, P=0.032). Conclusion:The BDQ-K is a reliable and valid instrument for identifying FGIDs. The prevalence of FD according to the Rome III criteria was 8.3% and that of IBS was 6.1%. (Ewha Med J 2011;34(2):39-46)

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Discriminant value of dyspeptic symptoms: a study of the clinical presentation of 221 patients with dyspepsia of unknown cause, peptic ulceration, and cholelithiasis.

Cited by 83 publications

References 20 publications

Clinical manifestations of gallstone disease: Evidence from the multicenter Italian study on cholelithiasis (MICOL)

Clinical manifestations of gallstone disease: Evidence from the multicenter Italian study on cholelithiasis (MICOL)

GPs' ability to diagnose dyspepsia based only on physical examination and patient history

Reliability and Validity of Korean Bowel Disease Questionnaire for Functional Gastrointestinal Disorders

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