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Item does not contain fulltext Acta van de 21e Nederlands-Vlaamse Filosofiedag

BACKGROUND: Data on the one-year prognosis of patients with non-organic, non-acute abdominal complaints in primary care are lacking. Knowledge of prognostic determinants could be helpful in management and health education. AIM: To describe the prognosis after one year of non-organic abdominal complaints in general practice, and to show how this relates to socio-demographic factors, medical history and psychological problems. METHODS: The one-year prognosis of patients with non-organic abdominal complaints in a primary care setting was analysed in a prospective study (n = 756). Clinical and psychological factors were measured and their relative risks regarding unfavourable prognosis were calculated one year after the first consultation. RESULTS: In 68% of the patients examined, the abdominal complaints had either improved or disappeared by the end of the first year. Female sex and depressive mental state were associated with an unfavourable prognosis. Clinical symptoms that were significantly associated with persisting complaints were a combination of abdominal pain, flatulence and bowel irregularities; a specific description of the character of the pain by the patient; looser stools at the onset of the pain; long duration or recurrence, pyrosis; absence of visible distension; and epigastric localization of the pain or tenderness. CONCLUSIONS: The prognosis after one year of non-acute abdominal pain in general practice is better than that reported from studies of outpatient populations. Female sex, depressive mood and some clinical parameters are associated with persistent complaints one year after presentation.

Family physicians encounter many pitfalls in managing and treating dyspeptic patients, most of whom are treated in family practice based solely on their signs and symptoms.A computer literature search followed by a systematic methodological appraisal was performed to identify studies that evaluated clinical symptomatology in dyspeptic patients.Ten studies, none of which took place in a family practice, fulfilled our inclusion criteria. The main conclusion drawn from outpatient populations and patients referred for open-access endoscopy was that certain clusters of symptoms have a negative predictive value for organic causes of dyspepsia. Higher age, male sex, pain at night, relief by antacids or food, and previous history of peptic ulcer disease were identified as predictors of organic causes for abdominal symptoms.These findings can be helpful to family physicians in determining the need for endoscopy referral. However, since the diagnostic values of tests in family practice may differ from those in referred populations, there is a need for prospective studies in primary care.

BACKGROUND. Although many patients are evaluated initially by their general practitioner, clinicians' accuracy at diagnosing organic gastrointestinal disease has not been studied in a primary care setting. Different spectra of severity of disease in general practice and hospital populations may lead to different values for diagnostic tests in these two populations. AIM. This study set out to determine the diagnostic value of history and physical and laboratory items for organic and neoplastic disease in general practice patients with nonacute abdominal complaints. METHOD. The one-year prospective, observational study was carried out in 1989 in 80 general practices in Limburg, the Netherlands. The study subjects were 933 patients (aged 18-75 years) presenting to their general practitioner with new non-acute abdominal complaints of minimum duration two weeks, and with whom the doctor had a diagnostic problem. Patients were physically examined by their general practitioner and asked to complete pre-structured questionnaires. Basic laboratory tests were carried out. Patients were followed up for at least one year by researchers and then a diagnosis was determined by an independent panel of three general practitioners using patient records, blinded for the results of the questionnaires. Sensitivity, specificity and odds ratios were calculated for clinical items. Stepwise forward logistic regression analysis was undertaken to identify independent predictors of organic gastrointestinal disease. RESULTS. Of the 933 patients 14% had organic gastrointestinal disease. No clinical item had both high sensitivity and specificity. Logistic regression analysis showed only eight independent predictors of organic disease: male sex, greater age, epigastric pain, no specific character to pain, pain affecting sleep, history of blood in stool, no pain relief after defecation and abnormal white blood cell count. When the model was programmed to predict neoplasms five items were found: male sex, greater age, no specific character to pain, weight loss and erythrocyte sedimentation rate greater than 20 mm hour-1. CONCLUSION. In a general practice population with non-acute abdominal complaints some clinical findings can be used as predictors for organic and neoplastic gastrointestinal disease.

Item does not contain fulltext

Item does not contain fulltext Acta van de 21e Nederlands-Vlaamse Filosofiedag

Item does not contain fulltext Acta van de 21e Nederlands-Vlaamse Filosofiedag