The diagnostic outcome of upper gastrointestinal endoscopy: Are referral source and patient age determining factors?

Objective: To evaluate the diagnostic outcome of upper gastrointestinal endoscopy at an open-access service for general practitioners (GPs) and specialists, with special attention to the, importance of referral source and patient age as determining factors.Patients: The study included 2900 patients (52.5% men& mean age 56 +/- 17.6 years) who underwent their first diagnostic upper gastrointestinal endoscopy between january 1989 and October 1990.Methods: General demographic characteristics, referral indications, pain localization, previous drug treatment and endoscopic diagnoses were compared by means of the two-sample t- or Chi-squared tests.Results: GP referrals (42%) were younger than specialist referrals (58%) with mean ages of 52 and 59 years, respectively. Compared with specialists, GPs referred their patients significantly more often because of dyspepsia and less often because of signs of gastrointestinal bleeding or anorexia and weight loss. Patients referred by their GP reported epigastric or retrosternal pain significantly more often and had been treated more frequently with ulcer-healing drugs prior to endoscopy. The proportion of relevant endoscopic findings did not differ between the two groups. The proportion of normal endoscopic investigations was lower in patients aged over 45 years than in those under 45 years. No malignant disorders were found in patients under 45 years of age.Conclusions: Our results provide strong evidence in favour of continuing the open-access endoscopy service for both GPs and specialists, if the aim of the diagnostic activity is the discovery of treatable disease. The expected proportion of relevant diagnoses is considerable in patients under 45 years of age. In those aged over 45 years, dyspeptic symptoms should be regarded as alarm symptoms.