Análise dos achados endoscópicos em clínica de endoscopia no período de 1991 a 2001: avaliação crítica da contribuição da endoscopia para diagnóstico do paciente dispéptico: estudo retrospectivo

Abstract

Dyspeptic symptoms show prevalence between 12.0% and 45.0%. They are responsible for 2.0% to 4.0% of all medical consultation. Up to now there isnt a guideline in Brazil based on analysis of scientific knowledge to show which patients with dyspepsia must be submitted to endoscopy. The goal of this study was to know the clinical and endoscopical characteristics of patients submitted to endoscopy(demographic data, reason for the exam and main endoscopical diagnosis), through the retrospective analysis of 12,261 included patients reports. There was predominance of women (52.9%). The main reasons for the endoscopic exam were non-specific dyspepsia (31.5%), ulcer dyspepsia (22.2%), dyspepsia due to motility disorders (9.3%) and gastroesophageal reflux symptoms (15.1%). The average ofage in the group was 43.1 years old and the median was 41 years old (Q1=30 and Q3=56). The average of age for patients with non-specific dyspepsia, ulcer dyspepsia, gastroesophageal reflux symptoms and dyspepsia due to motility disorders was 40.1, 41.9, 45.7 and 44.5 years old, respectively. The endoscopic exam was normal in 9.1% of the patients or presented minimum changes in 42.6% of them. Both diagnoses were predominant among female individuals and patients with non-specific dyspepsia or motility disorder dyspepsia (70.0%). Endoscopic exams with significant alterations were more common in males (57.4%) and patients with reflux symptoms (71.4%) or with ulcer dyspepsia (58.8%). The prevalence of erosive esophagitis and peptic ulcer increased gradually over 30 years old. Seventy-eight cases of gastric cancer were diagnosed among patients with dyspepsia and reflux. In this group occurred one case of gastric cancer below 30 years old (0.03%; OR = 30.7), 3 cases below 35 years old (0.07%; OR = 17), 8 cases below 40 years (0.2%; OR = 9.0), 15 cases below 45 years old (0.3%; OR = 6.6) and 22 gastric cancer cases when the age cut was 50 years (0.3; OR = 5.8). The odds ratio (OR) calculated to show the difference among the ages showed statistically significant differenceamong all the considered ages. The Helicobacter pylori infection was checked by the urease and histologic tests in 28.0% of the patients in this study. In this group, gastric cancer occurred in 18 patients. The OR for the infection in this group was significant (OR=4.1). We conclude that the correlation between the clinical data and endoscopic diagnoses suggested a major discrimination capacity for organic diseases among ulcer dyspeptic patients and the ones with reflux symptoms, and forfunctional diseases among patients with non-specific dyspepsia and motility disorder dyspepsia. This data, however, confirms the vulnerability of the clinical diagnosis for dyspepsia. Alternative strategies to endoscopic exam for patients with dyspepsia should consider the age group not over 30 or 35 years, considering that the age variable showed strong correlation with prevalence of gastric cancer.