Subscribe to RSS
DOI: 10.1055/s-2006-944661
Upper gastrointestinal endoscopy does not reassure patients with functional dyspepsia
Publication History
Submitted 29 January 2006
Accepted after revision 11 June 2006
Publication Date:
18 September 2006 (online)
Background and study aims: Upper gastrointestinal endoscopy in patients with functional dyspepsia is often carried out merely to reassure patients that symptoms are not due to serious pathology. The aim of this study was to compare anxiety, depression, and health-related quality of life as proxy values for reassurance in patients with functional dyspepsia before and after upper gastrointestinal endoscopy.
Patients and methods: Consecutive patients referred for endoscopy between February 2002 and February 2004 were included in the study. They were asked to score anxiety and depression using the Hospital Anxiety and Depression Scale, health-related quality of life using the EuroQol-5D questionnaire, and their impression of their own general health using a visual analogue scale, 2 weeks before endoscopy and again 1 month afterwards.
Results: A total of 420 patients were included, 42 % of whom were found to have an organic abnormality of some sort during upper gastrointestinal endoscopy. Neither the anxiety nor the depression frequencies differed significantly before and after endoscopy, either in patients with organic abnormalities at endoscopy or in those without. The general impression of health did not change after endoscopy either: organic abnormalities 62.7 ± 27.4 vs. 64.9 ± 24.2, P = 0.28; functional dyspepsia 61.0 ± 27.9 vs. 62.8 ± 27.2, P = 0.39. Only patients who had organic abnormalities reported a slightly improved quality of life 1 month after endoscopy: 0.74 ± 0.15 vs. 0.78 ± 0.12, P < 0.01.
Conclusion: In patients with functional dyspepsia, upper gastrointestinal endoscopy does not improve psychological well-being or health-related quality of life. In view of the invasiveness, cost, and potential harm associated with endoscopy, careful consideration should be given to whether this procedure should be carried out merely for the sake of the patient’s “peace of mind”.
References
- 1 Peura D A, Kovacs T O, Metz D C. et al . Lansoprazole in the treatment of functional dyspepsia: two double-blind, randomized, placebo-controlled trials. Am J Med. 2004; 116 740-748
- 2 Talley N J, Meineche-Schmidt V, Pare P. et al . Efficacy of omeprazole in functional dyspepsia: double-blind, randomized, placebo-controlled trials (the Bond and Opera studies). Aliment Pharmacol Ther. 1998; 12 1055-1065
- 3 Wong W M, Wong B C, Hung W K. et al . Double blind, randomised, placebo controlled study of four weeks of lansoprazole for the treatment of functional dyspepsia in Chinese patients. Gut. 2002; 51 502-506
- 4 Stanghellini V, Tosetti C, Barbara G. et al . Review article: the continuing dilemma of dyspepsia. Aliment Pharmacol Ther. 2000; 14 (Suppl 3) 23-30
- 5 Quadri A, Vakil N. Health-related anxiety and the effect of open-access endoscopy in US patients with dyspepsia. Aliment Pharmacol Ther. 2003; 17 835-840
- 6 Drossman D A, Talley N J, Leserman J. et al . Sexual and physical abuse and gastrointestinal illness: review and recommendations. Ann Intern Med. 1995; 123 782-794
- 7 Drossman D A, Creed F H, Olden K W. et al . Psychosocial aspects of the functional gastrointestinal disorders. Gut. 1999; 45 (Suppl 2) II25-II30
- 8 Koloski N A, Talley N J, Boyce P M. Epidemiology and health care seeking in the functional GI disorders: a population-based study. Am J Gastroenterol. 2002; 97 2290-2299
- 9 Locke G R 3rd, Weaver A L, Melton L J 3rd, Talley N J. Psychosocial factors are linked to functional gastrointestinal disorders: a population based nested case-control study. Am J Gastroenterol. 2004; 99 350-357
- 10 Whitehead W E, Bosmajian L, Zonderman A B. et al . Symptoms of psychologic distress associated with irritable bowel syndrome: comparison of community and medical clinic samples. Gastroenterology. 1988; 95 709-714
- 11 Haug T T, Svebak S, Wilhelmsen I. et al . Psychological factors and somatic symptoms in functional dyspepsia: a comparison with duodenal ulcer and healthy controls. J Psychosom Res. 1994; 38 281-291
- 12 Mones J, Adan A, Segu J L. et al . Quality of life in functional dyspepsia. Dig Dis Sci. 2002; 47 20-26
- 13 Chang L. Review article: epidemiology and quality of life in functional gastrointestinal disorders. Aliment Pharmacol Ther. 2004; 20 (Suppl 7) 31-39
- 14 El-Serag H B, Talley N J. Health-related quality of life in functional dyspepsia. Aliment Pharmacol Ther. 2003; 18 387-393
- 15 Bovenschen H J, Laheij R J, Tan A C. et al . Health-related quality of life of patients with gastrointestinal symptoms. Aliment Pharmacol Ther. 2004; 20 311-319
- 16 van Kerkhoven L A, van Rossum L G, van Oijen M G. et al . Anxiety, depression and psychotropic medication use in patients with persistent upper and lower gastrointestinal symptoms. Aliment Pharmacol Ther. 2005; 21 1001-1006
- 17 Sonnenberg A, Vakil N. The benefit of negative tests in non-ulcer dyspepsia. Med Decis Making. 2002; 22 199-207
- 18 Wilhelmsen I, Berstad A. Reduced relapse rate in duodenal ulcer disease leads to normalization of psychological distress: twelve-year follow-up. Scand J Gastroenterol. 2004; 39 717-721
- 19 Herrmann C. International experiences with the Hospital Anxiety and Depression Scale: a review of validation data and clinical results. J Psychosom Res. 1997; 42 17-41
- 20 Spinhoven P, Ormel J, Sloekers P P. et al . A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychol Med. 1997; 27 363-370
- 21 Johnston M, Pollard B, Hennessey P. Construct validation of the hospital anxiety and depression scale with clinical populations. J Psychosom Res. 2000; 48 579-584
- 22 Crawford J R, Henry J D, Crombie C. et al . Normative data for the HADS from a large non-clinical sample. Br J Clin Psychol. 2001; 40 429-434
- 23 Greiner W, Weijnen T, Nieuwenhuizen M. et al . A single European currency for EQ-5D health states: results from a six-country study. Eur J Health Econ. 2003; 4 222-231
- 24 van Agt H M, Essink-Bot M L, Krabbe P F. et al . Test-retest reliability of health state valuations collected with the EuroQol questionnaire. Soc Sci Med. 1994; 39 1537-1544
- 25 Wiklund I, Glise H, Jerndal P. et al . Does endoscopy have a positive impact on quality of life in dyspepsia?. Gastrointest Endosc. 1998; 47 449-454
- 26 Lucock M P, Morley S, White C. et al . Responses of consecutive patients to reassurance after gastroscopy: results of self administered questionnaire survey. BMJ. 1997; 315 572-575
- 27 Spiegel B M, Gralnek I M, Bolus R. et al . Is a negative colonoscopy associated with reassurance or improved health-related quality of life in irritable bowel syndrome?. Gastrointest Endosc. 2005; 62 892-899
- 28 Bytzer P, Hansen J M, Schaffalitzky de Muckadell O B. Empirical H2-blocker therapy or prompt endoscopy in management of dyspepsia. Lancet. 1994; 343 811-816
- 29 Ford A C, Qume M, Moayyedi P. et al . Helicobacter pylori “test and treat” or endoscopy for managing dyspepsia: an individual patient data meta-analysis. Gastroenterology. 2005; 128 1838-1844
- 30 Laheij R J, Hermsen J T, Jansen J B. et al . Empirical treatment followed by a test-and-treat strategy is more cost-effective in comparison with prompt endoscopy or radiography in patients with dyspeptic symptoms: a randomized trial in a primary care setting. Fam Pract. 2004; 21 238-243
- 31 Laheij R J, van Rossum L G, Heinen N. et al . Long-term follow-up of empirical treatment or prompt endoscopy for patients with persistent dyspeptic symptoms?. Eur J Gastroenterol Hepatol. 2004; 16 785-789
- 32 Lassen A T, Hallas J, Schaffalitzky de Muckadell O B. Helicobacter pylori test and eradicate versus prompt endoscopy for management of dyspeptic patients: 6.7 year follow up of a randomised trial. Gut. 2004; 53 1758-1763
- 33 Bovenschen H J, Rossum L G, Oijen M GH. et al . Health-related quality of life as an outcome in research. Drug Benefit Trends. 2004; 16 544-556
- 34 Jones M P, Sharp L K, Crowell M D. Psychosocial correlates of symptoms in functional dyspepsia. Clin Gastroenterol Hepatol. 2005; 3 521-528
L. van Kerkhoven, M. D.
Dept. of Gastroenterology and Hepatology
Radboud University Nijmegen Medical Center · PO Box 9101 · 6500 HB Nijmegen · The Netherlands
Fax: +31-243540103 ·
Email: l.vankerkhoven@mdl.umcn.nl