The efficacy of endoscopy in the evaluation of dyspepsia. A review of the literature and development of a sound strategy.

Diagnostic approaches to the patient with dyspepsia include immediate evaluation with an upper gastrointestinal series, immediate study with esophagogastroduodenoscopy (EGD), or empiric medical treatment, reserving diagnostic evaluation for patients with complications and persistent symptoms after therapy. A literature review of dyspepsia as a symptom, and of duodenal ulcer, gastric ulcer, gastroduodenitis, and gastric cancer summarizes how the diagnostic approaches to the dyspeptic patient affect the precision of diagnostic information, efficacy, patient outcome, and cost. For patients without clinically obvious disease, an approach is developed which reduces cost and retains optimal patient management. The strategy proposes the use of empiric medical therapy while reserving EGD for those few dyspeptic patients who have no or minimal response to therapy after 7 to 10 days, and for the approximately 30% of patients whose symptoms persist, improved, but not resolved after a 6 to 8 week period.