A Canadian physician survey of dyspepsia management
N Chiba | L Bernard | BJ O'Brien | R Goeree | et al
OBJECTIVE: To determine the management of patients with new onset
dyspepsia by Canadian family physicians.
METHODS: A survey was mailed to 195 family physicians
in August 1995 to identify how they manage dyspepsia
in patients according to four scenarios: based on presenting
symptoms alone; assuming Helicobacter pylori-positive;
known to be H pylori-negative; and endoscopically
confirmed nonulcer dyspepsia.
RESULTS: A total of 170 of 195 physicians (87.2%)
completed the survey. Physicians reported that 7.3%
of their practice is devoted to dyspepsia and 23% of
these dyspeptic patients present for the first time.
Ninety-three per cent of family physicians find a symptom
classification of ulcer-, reflux- and dysmotility-like
dyspepsia helpful. The majority of patients are advised
to make lifestyle changes and are treated with antacids
or empiric drug therapy. A H2 receptor antagonist was
the drug of choice for ulcer and reflux-like dyspepsia,
while prokinetics were often used for reflux and dysmotility-like
dyspepsia. After failure of initial treatment, patients
were given another course of empiric treatment, commonly
with cisapride or omeprazole. Family physicians estimated
that the mean time to obtain a gastrointestinal consult
was five weeks, and 70% indicated that this time to
consult adversely influenced their decision to refer.
If this time was reduced to less than two weeks, responding
physicians would consider referring all eligible patients.
On average, two to 2.5 courses of empiric therapy were
given before referral. If H pylori status was
known, fewer empiric treatments (mean 1.8) were given
before gastroenterological referral compared with the
other scenarios. If the patient had nonulcer dyspepsia,
30% of family physicians provided reassurance only and
did not prescribe empiric drug treatment.
CONCLUSIONS: Most newly dyspeptic patients in
Canada are treated with empiric therapy according to
symptom classification and referred for endoscopy after
an average two to 2.5 treatment courses.