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OBJECTIVE To identify patients with upper gastrointestinal symptoms and explore their clinical management in the primary care setting. METHOD The study population consisted of all patients who attended 5 rural health centers in the areas of Central Macedonia and Crete in Greece on 10 consecutive days. In total 992 patients were evaluated for upper gastrointestinal symptoms using questionnaires validated for Greek use: IDGP concerning dyspepsia and RDQ for Gastroesophageal Reflux Disease (GERD). All patients with positive indications were referred for upper endoscopy. Those patients who refused upper endoscopy were further evaluated for Helicobacter pylori (HP) infection with the urea breath test (UBT). RESULTS Of the 992 participants, 160 (16.12%) were found positive for dyspepsia according to the IDGP, while in 156 (15.72%) there were also symptoms of GERD. Twenty patients were found positive for HP through endoscopy and 65 through UBT. An increased frequency of upper gastrointestinal symptoms was observed in these two rural areas of Greece. CONCLUSIONS The use of specific questionnaires appears to contribute to the early identification and better clinical management of patients with upper gastrointestinal symptoms in primary care. [ABSTRACT FROM AUTHOR]

Objective: To validate the Reflux Symptom Index (RSI) in Greek patients and estimate the prevalence of laryngopharyngeal reflux (LPR) symptoms in the Greek population., Study Design: Prospective, controlled validation study., Setting: Tertiary referral hospital and primary care., Subjects and Methods: For validation purposes, the instrument was administered to 53 patients with confirmed LPR. Sex- and age-matched controls with no LPR or gastroesophageal reflux disease (GERD) symptoms presenting in a primary care setting composed the control group. Reliability and construct validity were statistically appraised. Using the RSI, the authors estimated the prevalence of LPR in a randomly selected sample of the Greek adult population., Results: The mean (SD) RSI score of the 172 sex- and age-matched controls was 3.2 (3.5). The mean (SD) RSI score of the 53 confirmed LPR patients was 19.9 (6.8). Cronbach α was 0.865. Factor analysis verified that the RSI instrument consists of 2 principal factors. To estimate the prevalence of LPR, a representative sample of the Greek adult population (188 subjects) completed the RSI questionnaire: 36.3% were male, and 29.6% were smokers. Mean (SD) age was 53.4 (17.7) years. The instrument was able to discriminate 16 patients with LPR symptoms with a mean (SD) score of 18.91 (6.39)., Conclusion: The authors evaluated the internal consistency, reliability, and construct validity of the RSI for the Greek population. Factor analysis of the Greek translation of the RSI demonstrated that it can be a reliable tool in the diagnostic approach of LPR patients. Using the RSI, the authors recorded that the prevalence of LPR in a representative sample of the Greek population is 8.5%.

Background: Upper gastrointestinal endoscopy is the most preferable diagnostic examination for patients over fifty when upper gastrointestinal symptoms appear. However, limited knowledge exists in concerns to the compliance of primary care patients' to the doctors' recommendations for endoscopy., Methods: Patients who visited primary care practices in Greece and experienced upper gastrointestinal symptoms within a 10 days screening study, were referred for an upper endoscopy exam. The patients which refused to complete the endoscopy exam, were interviewed by the use of an open- ended translated and validated questionnaire, the Identification of Dyspepsia in General Population (IDGP) questionnaire. A qualitative thematic analysis grounded on the theory of planned behavior was performed to reveal the reasons for patients' refusal, while socio-demographic predictors were also assessed., Results: Nine hundred and ninety two patients were recorded, 159 of them (16%) were found positive for dyspepsia and gastro-esophageal reflux disease according to the IDGP questionnaire. Out of the above, 131 (83.6%) patients refused further investigation with endoscopy. Patients who refused upper endoscopy were predominantly female (87.8%) (p = 0.036) and over the age of 50. The lack of severe symptoms, fear of pain, concerns of sedation, comorbidity and competing life demands were reported by patients as barriers to performing an endoscopic investigation., Conclusions: Patients with dyspepsia in rural Greece tend to avoid upper gastrointestinal endoscopy, with two major axons considered to be the causes of patients' refusal: their beliefs towards endoscopy and their personal capability to cope with it. Future research examining reasons of low compliance should be carried out in combination with modern behavioral theories so as to investigate into the above.