| Abstract |
Background
Functional dyspepsia (FD) and Gastroesophageal Reflux (GERD) disease
occur with a high frequency in the general population and in primary care
practices. Both diseases have very often, a great overlap of symptoms. The
absence of a verified pathophysiological mechanism for FD and the mainly
clinical diagnosis of GERD require the use of diagnostic criteria and
questionnaires. These diseases have not been studied extensively in Greece
and especially in Primary Health Care (PHC).
Aim
The aim of this thesis was to investigate the frequency of reported upper
gastrointestinal symptoms in populations of Rural Settings (RS) in Central
Macedonia and Crete. The main objective was to determine the incidence of
FD and GERD but also the confirmation of the initial diagnosis through
endoscopy. Other objectives of the study were to investigate the incidence of
infection with Helicobacter pylori and enhance a diagnostic tool for the
evaluation of GERD in primary care. Factors affecting patient compliance to
endoscopy were investigated. Quality of life of people with dyspepsia and
GERD was also assessed.
Population and methods
The study involved five RS, three from Central Macedonia and two from
Crete. The catchment population of these units was approximately 21,100
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people according to the 2011 census. All patients visiting for any reason, the
RS, within a period of 10 working days, were evaluated. In the first phase of
the study, patients were assessed with the standardized into Greek
questionnaire for dyspepsia, Identification of Dyspepsia in General Population
(IDGP). All positive patients were referred for upper gastrointestinal
endoscopy. Patients were also evaluated with the questionnaires Reflux
Disease Questionnaire (RDQ) for GERD and Quality of Life in Reflux and
Dyspepsia (QOLRAD) for quality of life. The RDQ questionnaire was validated
into Greek.
Positive patients were also evaluated for infection with Helicobacter pylori
either by biopsy during endoscopy or by Urea Breath Test (UBT).
In a second time, patients who refused to proceed to endoscopy were
interviewed in order to investigate the factors influencing their compliance. A
qualitative analysis of interviews was performed based on the Theory of
Planned Behaviour (TPB).
Results
In total 992 patients were evaluated. 160 of them were positive for of upper
gastrointestinal symptoms. Of these, only 28 performed gastroscopy. 106
patients were interviewed to investigate the factors of non-compliance to
upper endoscopy.
The RDQ questionnaire was completed from 160 patients. The validation
procedure of the Greek version showed a generally high internal consistency
(alpha value: 0.91). The kappa coefficient was rather low (0.20, 95% CI:
0.04, 0.36) while the entire agreement between the RDQ and IDGP
questionnaire was 70.5%.
According to the RDQ questionnaire, 112 of 160 patients (71.8%) were found
to suffer from GERD. Of these, 110 patients were tested for infection with
Helicobacter pylori and 65 were found positive. Quality of life was evaluated
in 157 out of 160 patients with upper gastrointestinal symptoms. Women
compared with men had poorer quality of life in all five areas of QOLRAD. No
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statistically significant differences were observed in patients according to their
geographical distribution and their age group.
Conclusions
The study shows that FD and GERD are very common in the population
visiting primary care practices, even though they are not patients’ main
complaint. Furthermore, these patients show increased incidence of infection
with H. pylori. It is interesting that patients shawed low compliance to the
referral for upper gastrointestinal endoscopy.
The finding that female patients have a poorer quality of life than men seems
to be verified in the present study.
These data should be considered in the clinical management of patients with
dyspepsia and GERD in primary care, but also in the design of services.
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Αξιολόγηση της διαχείρισης ασθενών με συμπτώματα του ανώτερου πεπτικού στην Πρωτοβάθμια Φροντίδα Υγείας
