Download PDF
Endoscopy 2006; 38(9): 879-885
DOI: 10.1055/s-2006-944661
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Upper gastrointestinal endoscopy does not reassure patients with functional dyspepsia

L.  A.  S.  van Kerkhoven1, 2 , L.  G.  M.  van Rossum1 , M.  G.  H.  van Oijen1 , A.  C.  I.  T.  L.  Tan2 , R.  J.  F.  Laheij1 , J.  B.  M.  J.  Jansen1
  • 1Dept. of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
  • 2Dept. of Gastroenterology and Hepatology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
Further Information

Publication History

Submitted 29 January 2006

Accepted after revision 11 June 2006

Publication Date:
18 September 2006 (online)

Also available at
    Permissions and Reprints

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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 12 Mones J, Adan A, Segu J L. et al . Quality of life in functional dyspepsia.  Dig Dis Sci. 2002;  47 20-26
    CrossrefPubMedGoogle Scholar
  • 13 Chang L. Review article: epidemiology and quality of life in functional gastrointestinal disorders.  Aliment Pharmacol Ther. 2004;  20 (Suppl 7) 31-39
    PubMedGoogle Scholar
  • 14 El-Serag H B, Talley N J. Health-related quality of life in functional dyspepsia.  Aliment Pharmacol Ther. 2003;  18 387-393
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 17 Sonnenberg A, Vakil N. The benefit of negative tests in non-ulcer dyspepsia.  Med Decis Making. 2002;  22 199-207
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 34 Jones M P, Sharp L K, Crowell M D. Psychosocial correlates of symptoms in functional dyspepsia.  Clin Gastroenterol Hepatol. 2005;  3 521-528
    CrossrefPubMedGoogle Scholar

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

      >