Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://www.gastrores.org

Original Article

Volume 14, Number 2, April 2021, pages 81-86

Single-Center Review of Appropriateness and Utilization of Upper Endoscopy in Dyspepsia in the United States

**Table 1.** Characteristics of Patients Undergoing EGD for Dyspepsia, n (%)
Characteristics	Overall	Appropriate	Inappropriate	P value
EGD: esophagogastroduodenoscopy; OSA: obstructive sleep apnea.
Total number	122	30	92
Age (years)
< 40	32 (26.2%)	0	32 (34.8%)	< 0.001
40 - 60	60 (49.2%)	0	60 (65.2%)	< 0.001
≥ 60	30 (24.6%)	30 (100%)	0	< 0.001
Female sex	79 (64.8%)	20 (66.6%)	59 (64.1%)	0.891
Comorbidities
Hypertension	19 (15.6%)	9 (30%)	10 (10.9%)	0.019
Diabetes	12 (9.8%)	3 (10%)	9 (9.8%)	1
Obesity	9 (7.4%)	2 (6.6%)	7 (7.6%)	1
OSA	6 (4.9%)	1 (3.3%)	5 (5.4%)	1
Psychiatric comorbidities
Depression	20 (26.3%)	7 (23.3%)	13 (14.1%)	0.26
Anxiety	21 (27.3%)	5 (16.6%)	16 (17.4%)	1
Substance abuse	16 (13.1%)	4 (13.3%)	12 (13%)	1
Referring provider
Gastroenterology MD/DO	50 (41%)	11 (36.7%)	39 (42.2%)	0.671
Gastroenterology NP/PA	56 (45.9%)	17 (56.6%)	39 (42.2%)	0.207
PCP MD/DO	9 (7.4%)	2 (6.7%)	7 (7.6%)	1
PCP NP/PA	3 (2.5%)	0	3 (3.7%)	1
Duration of symptoms
< 6 months	47 (38.5%)	13 (43.3%)	34 (37%)	0.666
6 months to 1 year	13 (10.7%)	5 (16.6%)	8 (8.7%)	0.304
> 1 year	39 (32%)	5 (16.6%)	34 (37%)	0.044
Not mentioned	21 (17.2%)	7 (7.6%)	14 (15.2%)	0.403
Alarm symptoms
Weight loss	13 (10.7%)	1 (3.3%)	12 (13%)	0.183
Melena	3 (2.5%)	2 (6.7%)	1 (1.1%)	0.149
Early satiety	3 (2.5%)	2 (6.7%)	1 (1.1%)	0.149

Table 1. Characteristics of Patients Undergoing EGD for Dyspepsia, n (%)

Characteristics

Overall

Appropriate

Inappropriate

P value

EGD: esophagogastroduodenoscopy; OSA: obstructive sleep apnea.

Total number

122

Age (years)

< 40

32 (26.2%)

32 (34.8%)

< 0.001

40 - 60

60 (49.2%)

60 (65.2%)

< 0.001

≥ 60

30 (24.6%)

30 (100%)

< 0.001

Female sex

79 (64.8%)

20 (66.6%)

59 (64.1%)

0.891

Comorbidities

Hypertension

19 (15.6%)

9 (30%)

10 (10.9%)

0.019

Diabetes

12 (9.8%)

3 (10%)

9 (9.8%)

Obesity

9 (7.4%)

2 (6.6%)

7 (7.6%)

OSA

6 (4.9%)

1 (3.3%)

5 (5.4%)

Psychiatric comorbidities

Depression

20 (26.3%)

7 (23.3%)

13 (14.1%)

0.26

Anxiety

21 (27.3%)

5 (16.6%)

16 (17.4%)

Substance abuse

16 (13.1%)

4 (13.3%)

12 (13%)

Referring provider

Gastroenterology MD/DO

50 (41%)

11 (36.7%)

39 (42.2%)

0.671

Gastroenterology NP/PA

56 (45.9%)

17 (56.6%)

39 (42.2%)

0.207

PCP MD/DO

9 (7.4%)

2 (6.7%)

7 (7.6%)

PCP NP/PA

3 (2.5%)

3 (3.7%)

Duration of symptoms

< 6 months

47 (38.5%)

13 (43.3%)

34 (37%)

0.666

6 months to 1 year

13 (10.7%)

5 (16.6%)

8 (8.7%)

0.304

> 1 year

39 (32%)

5 (16.6%)

34 (37%)

0.044

Not mentioned

21 (17.2%)

7 (7.6%)

14 (15.2%)

0.403

Alarm symptoms

Weight loss

13 (10.7%)

1 (3.3%)

12 (13%)

0.183

Melena

3 (2.5%)

2 (6.7%)

1 (1.1%)

0.149

Early satiety

3 (2.5%)

2 (6.7%)

1 (1.1%)

0.149

**Table 2.** Real-World Management of Patients With Dyspepsia
Intervention	Total number (%)
US: ultrasonography; HIDA: hepatobiliary iminodiacetic acid; SIBO: small intestinal bacterial overgrowth; PPI: proton pump inhibitor.
H. pylori test
Positive	12 (9.8%)
Treatment completed	6 (4.9%)
Negative	18 (14.8%)
Not performed	92 (75.4%)
Other diagnostic tests performed
Celiac testing	3 (2.5%)
Gastric emptying study	2 (1.6%)
Right upper quadrant US/HIDA	2 (1.6%)
SIBO testing	1 (0.8%)
PPI used
< 6 months	23 (18.6%)
6 months to 1 year	23 (18.6%)
> 1 year	17 (13.9%)
Not used	47 (38.5%)
Other treatments
H₂-blockers	6 (4.8%)
Mag sulfate	3 (2.4%)
Sucralfate	2 (1.6%)
Amitriptyline	1 (0.8%)
Miralax	1 (0.8%)
Previous endoscopy performed	7 (5.7%)

Table 2. Real-World Management of Patients With Dyspepsia

Intervention

Total number (%)

US: ultrasonography; HIDA: hepatobiliary iminodiacetic acid; SIBO: small intestinal bacterial overgrowth; PPI: proton pump inhibitor.

H. pylori test

Positive

12 (9.8%)

Treatment completed

6 (4.9%)

Negative

18 (14.8%)

Not performed

92 (75.4%)

Other diagnostic tests performed

Celiac testing

3 (2.5%)

Gastric emptying study

2 (1.6%)

Right upper quadrant US/HIDA

2 (1.6%)

SIBO testing

1 (0.8%)

PPI used

< 6 months

23 (18.6%)

6 months to 1 year

23 (18.6%)

> 1 year

17 (13.9%)

Not used

47 (38.5%)

Other treatments

H₂-blockers

6 (4.8%)

Mag sulfate

3 (2.4%)

Sucralfate

2 (1.6%)

Amitriptyline

1 (0.8%)

Miralax

1 (0.8%)

Previous endoscopy performed

7 (5.7%)

**Table 3.** Finding on EGD and Comparison Based Upon the Appropriateness of the EGD
Diagnosis	Appropriate UGE	Inappropriate UGE	P value
EGD: esophagogastroduodenoscopy; UGE: upper gastrointestinal endoscopy.
Hiatal hernia	4	13.3%	0	0.0%	0.01
Gastritis/duodenitis	9	30.0%	15	16.3%	0.116
Esophagitis	1	3.3%	3	3.2%	1
Celiac disease	1	3.3%	1	1.1%	0.432
Schatzki ring	1	3.3%	1	1.1%	0.432
Barrett’s esophagus	2	6.6%	0	0.0%	0.058
Gastric ulcer	1	3.3%	1	1.1%	0.432
Total	19	63.30%	21	22.8%	< 0.001

Table 3. Finding on EGD and Comparison Based Upon the Appropriateness of the EGD

Diagnosis

Appropriate UGE

Inappropriate UGE

P value

Number

% of total

Number

% of total

EGD: esophagogastroduodenoscopy; UGE: upper gastrointestinal endoscopy.

Hiatal hernia

13.3%

0.0%

0.01

Gastritis/duodenitis

30.0%

16.3%

0.116

Esophagitis

3.3%

3.2%

Celiac disease

3.3%

1.1%

0.432

Schatzki ring

3.3%

1.1%

0.432

Barrett’s esophagus

6.6%

0.0%

0.058

Gastric ulcer

3.3%

1.1%

0.432

Total

63.30%

22.8%

< 0.001