UPPER GASTROINTESTINAL SYMPTOMS IN GENERAL-PRACTICE - A MULTICENTER UK STUDY

The study was designed to identify patterns of dyspeptic symptoms in patients presenting to General Practitioners and to determine whether a classification based on published symptom sub-groups con be used to predict which patients respond best to treatment with a prokinetic. It was a multicentre study involving symptom assessment before and after four weeks' open treatment with 10mg cisapride tid and after a further four-week period without treatment. Patients presenting with dyspepsia, whom General Practitioners considered suitable for a trial of therapy without prior gastrointestinal investigation, were recruited to the study and their symptoms were recorded. Symptoms were recorded from 9,974 patients, of whom 7,928 completed the treatment phase and 5,125 returned at the end of the follow-up Period. Symptom occurrence and severity were recorded before and after treatment The pattern of symptom presentation was compared with pre-defined symptom sub-groups, and the response rates of different sub-groups to treatment were analysed. Only half the patients (n=4,518) could be categorised according to the predefined dyspepsia sub-groups: 27.9% had ulcer-like, 12.1% dysmotility-like and 4.1% reflux-like dyspeptic symptoms. The other patients had symptoms associated with more than one sub-group. Symptom patterns and sub-group distribution were not related to patients' age or sex and showed no regional variation. After four weeks of treatment with cisopride, 89.9% of patients showed symptom improvement which was sustained for a further four weeks after treatment in most patients (63.3%). Response rates to treatment with cisapride were similar in all sub-groups (range 84-92%). We conclude that symptom sub-groups ore not helpful in predicting response to treatment with a prokinetic.