“Dyspepsia Questionnaire” for optimizing the management of patients with dyspeptic syndrome

Background. One in five people worldwide has symptoms of dyspepsia, which causes a high incidence of these symptoms in real clinical practice. To help practitioners in the world, questionnaires have been repeatedly created to identify or control symptoms of dyspepsia, but most of them are complex, difficult, and provide subjective information about symptoms for the previous period. In the presented study, we have developed an original «Dyspepsia Questionnaire» considering the most common combination of symptoms in the framework of dyspeptic syndrome and comorbid nosologies.

Aim – to develop a «Dyspepsia Questionnaire» considering comorbid nosologies to optimize the management of patients with unspecified dyspepsia syndrome.

Materials and methods. The design of the study included three stages. During the first stage, 856 patients with unspecified dyspepsia were included, who underwent a 13C-Urea Breath test. According to its results, 342 patients with H. pylori (Hp) infection were excluded from the study. 514 patients with negative Hp status underwent esophagogastroduodenoscopy (EGDS) and ultrasound of the abdominal cavity. 129 patients were diagnosed with organic pathology, and they were also excluded from the research. Of the 385 patients without organic pathology, 208 people agreed to undergo a full laboratory and instrumental examination. At the second stage, the «Dyspepsia Questionnaire» was developed. At the third stage, 208 patients filled out a questionnaire retrospectively and prospectively (simultaneously for the previous 7 days and daily for 7 days) and underwent additional examination: experimental psychological testing: Beck, generalized anxiety disorder questionnaires-7 (GAD-7), Short Form (SF)-36 and laboratory and instrumental examination: pepsinogen level I, pepsinogen II, gastrin-17 and IgG to H. serum pylori, EGDS with biopsy and pathomorphological assessment using the Operative Link for Gastritis Assessment (OLGA) system, daily pH-impedansometry of the esophagus, radiography of the esophagus and stomach. At the end of the third stage, the correspondence of the diagnosis according to the questionnaire and the final diagnosis according to the results of laboratory and instrumental examination was determined. Patients appreciated the simplicity, convenience and time of filling out the questionnaire, two hundred doctors appreciated the informative content of the questionnaire, convenience and time to analyze the results.

Results. The most frequent nosologic variants of secondary dyspepsia in patients were biliary stone disease – 37 (28.6 %) patients, duodenal ulcer disease – 26 (20 %) patients and erosive esophagitis of grade B, C and D according to LA classification – 24 (18.6 %) patients. Laboratory and instrumental examinations of 208 patients showed that more than half of the patients (112 patients, 54 %) had functional dyspepsia (FD) combined with gastroesophageal reflux disease (GERD): non-erosive esophagitis – 81 (72 %) or erosive esophagitis A degree according to LA classification – 31 (28 %). The most frequent diagnoses were the combination of two forms of PD – 49 (23.5 %) patients and combination of GERD and PD with epigastric pain syndrome (EPS) – 47 (22.5 %) patients. To calculate the accuracy, sensitivity and specificity of the test for each diagnosis, the results of prospective completion of the questionnaire were compared with the final diagnosis. Daily prospective completion of the dyspepsia questionnaire showed higher comparability with the final diagnosis than retrospective completion: sensitivity for prospective completion was 95.7 %, specificity 99.4 %, accuracy 98.7 %, sensitivity for retrospective completion was 73.1 %, specificity 95.5 %, accuracy 91.5 %.

Conclusions. Given the vastness of nosological variants of dyspeptic syndrome, the detection of a high percentage of a combination of GERD and PD, both variants of PD, the «Dyspepsia Questionnaire» can be a tool for optimizing the management of patients with unspecified dyspepsia, further differential diagnosis, and a tool for controlling symptoms before and during therapy. The «Dyspepsia Questionnaire» is simple, convenient and informative for the patient to fill out and interpret by the doctor in written and online formats.

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