1
|
Westbrook JI, Duggan AE, Duggan JM, Westbrook MT. A 9 year prospective cohort study of endoscoped patients with upper gastrointestinal symptoms. Eur J Epidemiol 2005; 20:619-27. [PMID: 16119436 DOI: 10.1007/s10654-005-4304-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Despite the high prevalence of upper gastrointestinal symptoms and associated costs of diagnosis and management, evidence regarding long-term outcomes is scant. We studied symptom outcomes 18 months (FU1) and 8/9 years (FU2) post-index endoscopy to identify demographic, diagnostic and treatment factors associated with outcomes. A retrospective review of medical records at two Australian teaching hospitals identified a cohort of 302 patients who had an index endoscopy (performed by 23 endoscopists) 18 months previously. Patients were interviewed at FU1 and FU2. In total 34% (95%CI: 29.0 39.8) of patients were asymptomatic at FUI and 41% (95%CI: 35.6-46.6) at FU2. For 63%, outcomes at FUI predicted long-term outcome, with 19% (95%CI: 14.6-23.4) asymptomatic and 44% (95%CI: 38.4-50.0) symptomatic at both times. Those whose symptom status changed were as likely to deteriorate as improve (p > 0.05). Number and severity of presenting symptoms (F = 3.3, df = 3,277, p < 0.05) and older age (F = 2.8, df = 2,301, p < 0.05) were associated with poorer outcomes. Long-term outcome was unrelated to endoscopic diagnosis. Those symptomatic were significantly more likely to be on proton pump inhibitors (PPIs) or Histamine2 Receptor Antagonists (H2RAs) than those who were asymptomatic. Use of PPIs at FU2 was associated with a significantly better outcome than use of H2RAs. However this impact was relatively small, with 69% of patients on PPIs and 84% on H2RAs symptomatic at FU2. Upper gastrointestinal symptoms prompting endoscopy are chronic for the majority of patients regardless of diagnosis. Endoscopic diagnosis is of limited value in predicting long-term outcomes. The association between poor outcome and use of H2RAs and PPIs challenges views about their long-term effectiveness in symptom control.
Collapse
Affiliation(s)
- Johanna I Westbrook
- Centre for Health Informatics, University of NSW, Kensington, NSW, Australia.
| | | | | | | |
Collapse
|
2
|
Abstract
AIM To examine the prevalence of functional dyspepsia in the general population, and to evaluate the natural history/clinical course of patients with functional dyspepsia. METHODS Full-length published manuscripts during 1980-2002 were included if: (i) participants had uninvestigated or functional dyspepsia; (ii) dyspepsia was defined; (iii) for prevalence, population-based samples were evaluated; (iv) for prognosis, the total number of the inception cohort and the total number of individuals available at the end of follow-up were reported. RESULTS Twenty-two studies (1976-2002) that examined the prevalence of dyspepsia fulfilled the inclusion and exclusion criteria; 17 studies examined more than 1000 participants, but only two studies provided information sufficient to calculate the prevalence of functional dyspepsia (11.5-14.7%). The prevalence of uninvestigated dyspepsia was in the range 10-40%. When the definition of dyspepsia was restricted to participants with upper abdominal pain, irrespective of the presence of heartburn or acid regurgitation, the prevalence rate estimate was 5-12%. Thirteen studies examined the clinical course of functional dyspepsia (seven retrospective and six prospective). Sample sizes were small (n = 35-209). A follow-up ascertainment of symptoms amongst individuals in the original cohorts was obtained in 92.5-98.2% of prospective studies and in 67.7-82.2% of retrospective studies. The follow-up duration was in the range 1.5-10 years for prospective studies and 5-27 years for retrospective studies; the median follow-up duration for all studies was approximately 5 years. A variable prognosis was reported. An outcome of symptom improvement or becoming asymptomatic was reported in at least one-half of patients in 10 of the 13 studies, and in at least two-thirds of patients in six of the 13 studies. Prognostic factors were inconsistent and, in general, poorly described. CONCLUSIONS Functional dyspepsia is prevalent world-wide, but the prognosis remains poorly defined. There is a need for population-based studies to examine the prevalence and clinical course of documented functional dyspepsia.
Collapse
Affiliation(s)
- H B El-Serag
- Sections of Gastroenterology and Health Services Research, Houston Veterans Affairs Medical Center, and Baylor College of Medicine, Houston, TX, USA.
| | | |
Collapse
|
3
|
Kooiman CG, Bolk JH, Rooijmans HGM, Trijsburg RW. Alexithymia does not predict the persistence of medically unexplained physical symptoms. Psychosom Med 2004; 66:224-32. [PMID: 15039507 DOI: 10.1097/01.psy.0000116714.38868.06] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Alexithymia is thought to be associated with the development of medically unexplained physical symptoms (UPS). So far little research has been published on alexithymia as a risk factor for the persistence of UPS. OBJECTIVE To determine the clinical outcome in UPS patients and to study the relative importance of alexithymia in predicting that outcome. METHODS A follow-up study was conducted among general medical outpatients with UPS. Patients underwent extensive examinations at baseline and were reassessed after a mean 61-week interval. Outcome of the UPS and general health perception at follow-up were used as major outcome variables. RESULTS Outcome of the UPS and general health perception at follow-up were not strongly associated with each other. More than half (63%) of the patients reported improvement of their initial symptoms, but only 38% of the patients considered themselves at follow-up to be in good health. UPS outcome was predominantly predicted by the duration of the UPS and the number of additional physical symptoms at baseline. General health perception at follow-up was predominantly predicted by the general health perception at baseline and the number of additional physical symptoms and pain experience at baseline. The explained variance of the general health perception was three times as high as the explained variance for the UPS outcome. Alexithymia was not associated with any of the two outcome variables. CONCLUSIONS Outcome of the UPS and general health perception at follow-up are not strongly associated and are predicted by different variables. Alexithymia, however, is not an important predictor for the outcome in the majority of UPS patients.
Collapse
Affiliation(s)
- Cornelis G Kooiman
- Department of Psychiatry of the Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | |
Collapse
|
4
|
|
5
|
Gutiérrez A, Rodrigo L, Riestra S, Fernández E, Cadahia V, Tojo R, Fuentes D, Niño P, Olcoz JL. Quality of life in patients with functional dyspepsia: a prospective 1-year follow-up study in Spanish patients. Eur J Gastroenterol Hepatol 2003; 15:1175-81. [PMID: 14560150 DOI: 10.1097/00042737-200311000-00005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS The natural history of functional dyspepsia is not well known. We prospectively assess the quality of life and severity of symptoms in a group of Spanish patients with functional dyspepsia. PATIENTS AND METHODS One hundred and twelve consecutive patients with functional dyspepsia, according to Rome II criteria, were prospectively followed up for 1 year. All patients completed symptom (Dyspepsia Questionnaire and the Gastrointestinal Symptoms Rating Scale) and quality of life [the Psychological General Well-Being (PGWB) Index and the General Health Questionnaire (GHQ)] questionnaires every 3 months. Only free antacid consumption was permitted during the study period. RESULTS The group was made up of 81 women and 31 men with a mean age of 45 +/- 17 years; 66% of patients were infected with Helicobacter pylori, and ulcer-like dyspepsia (53%) was the predominant subgroup. At baseline, quality of life scores were low (PGWB, 87.1 +/- 17.6 and GHQ, 20.6 +/- 11.8), but these values gradually improved during the year of follow-up (PGWB, 107.7 +/- 1.1 and GHQ, 8.9 +/- 0.4). Digestive symptoms also decreased. In the multivariate analysis, the anxiety score on the PGWB index (Wald, 5.2; P = 0.02) and smoking status (Wald, 4.3; P = 0.04) were predictors of end quality of life. At baseline, patients with a high level of anxiety had a very reduced quality of life, although their symptom scores were similar to other patients. CONCLUSION Quality of life is reduced in patients with functional dyspepsia. Some improvement in quality of life together with a decrease in the severity of symptom scores was seen during the 1 year of follow-up. We believe that both the reassurance of negative endoscopy and the scheduling of visits to the doctor favourably influence the quality of life.
Collapse
Affiliation(s)
- Ana Gutiérrez
- Gastroenterology Unit, Hospital Virgen Blanca, León, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Spiegel BMR, Vakil NB, Ofman JJ. Dyspepsia management in primary care: a decision analysis of competing strategies. Gastroenterology 2002; 122:1270-85. [PMID: 11984514 DOI: 10.1053/gast.2002.33019] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Brennan M R Spiegel
- Department of Medicine and Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | |
Collapse
|
7
|
Abstract
OBJECTIVES Negative diagnostic tests are usually evaluated by their ability to advance a diagnostic search, or they are considered redundant expenditures in establishing a definitive diagnosis. It has remained difficult to assess their benefit in terms of their own merit and the reassurance that they provide to a patient. The aim of the present study is to develop a mathematical model for quantifying the impact of diagnostic tests on a patient's health-related quality of life (HRQL). METHODS An influence diagram is used to model how non-ulcer dyspepsia (NUD) and its medical care affect HRQL. Diagnostic tests and medical therapy benefit HRQL by alleviating fear of disease and NUD symptoms. Medical care can also adversely affect HRQL, lead to expenses in time and money, and compromise a patient's sense of autonomy. HRQL is modeled as the focal point of multiple influences detracting from its value. RESULTS Negative diagnostic tests can improve HRQL in NUD. The improvement of HRQL by diagnostic tests depends on a multitude of individual influences and the interactions between them, such as the severity of NUD symptoms andfear of disease, as well as the impact of medical care itself on HRQL. If a patient harbors a strong fear of serious disease or cancer, more extensive testing is likely to improve the patient's well-being and appears a worthwhile endeavor. Other patients, however, would be served perfectly well by empirical therapy only. For the vast majority of subjects with NUD who never seek medical advice, the unpleasantness of the disease itself does not outweigh the anticipated downside of obtaining medical care. CONCLUSION The analysis illustrates the applicability of the influence diagram in modeling disease behavior. This method helps to assess the benefit of negative tests beyond their means of generating information.
Collapse
Affiliation(s)
- Amnon Sonnenberg
- Department of Veterans Affairs Medical Center, Albuquerque, New Mexico 87108, USA.
| | | |
Collapse
|
8
|
Quartero AO, Numans ME, Post MWM, de Melker RA, de Wit NJ. One-year prognosis of primary care dyspepsia: predictive value of symptom pattern, Helicobacter pylori and GP management. Eur J Gastroenterol Hepatol 2002; 14:55-60. [PMID: 11782576 DOI: 10.1097/00042737-200201000-00010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS Dyspepsia is a highly prevalent, heterogeneous condition with a poorly defined clinical course in family practice. We observed its clinical outcome and identified prognostic factors. PATIENTS We studied 583 patients presenting to their general practitioner (GP) with a new episode of dyspeptic complaints. METHODS A validated dyspepsia severity score was used to observe deterioration of dyspepsia. Furthermore, the general health status and the patient's perception of no improvement were registered. As prognostic determinants, demographic characteristics, concomitant conditions, and management were studied. Univariate and multivariate analyses were performed. RESULTS A total of 518 (89%) patients completed the 1-year follow-up. Of these, 111 patients (22%, 95% CI 18% to 25%) had a negative change in their dyspepsia score after 1 year; 46 patients (9%, 95% CI 6% to 11%) noted impairment of general health; and 122 patients (24%, 95% CI 20% to 28%) regarded complaints as not improved. Frequent dyspepsia (>1 episode/year) and a history of peptic ulcer predicted deterioration of dyspepsia, while smoking and little psychological distress predicted impairment of general health. Eradication of Helicobacter pylori reduced the chance of patient's negative judgement for especially those with frequent dyspepsia. CONCLUSION One-quarter of the dyspepsia patients had an unfavourable 1-year prognosis, which was predictable because of frequent complaints and previously diagnosed ulcers. Psychological factors need to be identified, since they are related to general health improvement. The observed benefit of H. pylori eradication on perceived improvement of complaints may well be placebo effect.
Collapse
Affiliation(s)
- A Otto Quartero
- Julius Centre for General Practice and Patient Oriented Research, University Medical Centre, Utrecht, The Netherlands.
| | | | | | | | | |
Collapse
|
9
|
Cheng C. Seeking medical consultation: perceptual and behavioral characteristics distinguishing consulters and nonconsulters with functional dyspepsia. Psychosom Med 2000; 62:844-52. [PMID: 11139005 DOI: 10.1097/00006842-200011000-00015] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Subjects with functional dyspepsia (FD) in most previous studies have been confined to those who sought medical consultation. The generalizability of results from these studies to individuals with FD who do not seek medical consultation is limited. This study examined 1) differences in perceptual and behavioral characteristics between "nonconsulters" and "consulters" with FD and 2) the influence of these characteristics on dyspeptic and psychological symptoms. METHODS A matched case-control design was used to compare differences among 43 nonconsulters with FD, 43 consulters with FD, and 43 healthy individuals. Subjects' monitoring perceptual style, confrontative coping behaviors, dyspeptic symptoms, anxiety, and depression were assessed by using well-validated questionnaires. RESULTS FD consulters exhibited higher levels of monitoring, confrontative coping, anxiety, and depression than FD nonconsulters and healthy subjects (p values < .01). Results from discriminant analysis revealed that all these variables reliably predicted the membership of the three groups. Significant Monitoring by Confrontative Coping interaction effects were also found, indicating the conjoint influences of these variables on dyspeptic and psychological symptoms. CONCLUSIONS These results show that FD nonconsulters are distinguishable from FD consulters by their perceptual style, coping behaviors, and psychological symptoms. Both monitoring perceptual style and confrontative coping behaviors may magnify dyspeptic and psychological symptoms in individuals with FD, especially those who seek medical consultation.
Collapse
Affiliation(s)
- C Cheng
- Division of Social Science, Hong Kong University of Science and Technology, Kowloon.
| |
Collapse
|
10
|
Cheng C, Hui W, Lam S. Perceptual style and behavioral pattern of individuals with functional gastrointestinal disorders. Health Psychol 2000; 19:146-54. [PMID: 10762098 DOI: 10.1037/0278-6133.19.2.146] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The present research examined the perceptual style and coping pattern characterizing individuals with functional gastrointestinal disorders. A matched case-control design was adopted to compare differences among the target group of individuals with functional gastrointestinal disorders (n = 40), a pain control group of individuals with rheumatism (n = 40), and the community control group of healthy individuals (n = 40). Perceptual style was measured by both monitoring and blunting responses to hypothetical stressful situations, and coping pattern was measured by the use of coping strategies in real-life stressful events. Results revealed that participants with functional gastrointestinal disorders differed from their healthy and rheumatic counterparts in having higher monitoring and lower blunting scores and using action-oriented coping strategies regardless of the controllability of stressful situations.
Collapse
Affiliation(s)
- C Cheng
- Division of Social Science, Hong Kong University of Science and Technology, Kowloon.
| | | | | |
Collapse
|
11
|
Abstract
PURPOSE Dyspepsia is a common primary care condition, yet its optimal management is poorly defined. We reviewed the literature to answer the following questions about patients with dyspepsia: 1) Does endoscopy result in improved patient outcomes? 2) Does endoscopy result in a reduction in the use of subsequent medical resources? 3) Does endoscopy result in improved medical decision making? 4) Is endoscopy cost effective? METHODS We performed a systematic review of English-language articles in the MEDLINE, HEALTHSTAR, and EMBASE computerized bibliographic databases from January 1985 to July 1998. We included all studies, including decision analyses, with information about the effectiveness of endoscopy, as measured by its impact on patient outcomes, resource utilization, clinical decision making, or cost effectiveness. Two independent reviewers abstracted data from each study, and assessed its methodologic quality. RESULTS Twenty-one studies met the inclusion criteria. For 3 of the 4 clinical questions, the weight of evidence does not support the effectiveness of endoscopy. The largest randomized clinical trial comparing endoscopy with empiric therapy demonstrates equivalent symptoms and quality of life at 1 year, with increased patient satisfaction and lower costs for initial endoscopy. Suboptimal study design, including lack of appropriate comparison groups, limit studies measuring the impact of endoscopy on resource utilization and decision-making. Decision analyses indicate that noninvasive H pylori testing followed by anti-H pylori therapy or empiric antisecretory therapy is more cost effective than initial endoscopy. CONCLUSIONS With the exception of one randomized clinical trial, the preponderance of available data does not support the effectiveness of endoscopy in the management of dyspepsia. Prospective clinical trials that evaluate patient outcomes and resource utilization, and take H pylori status into account, are needed to determine the effectiveness of endoscopy in the management of dyspepsia.
Collapse
Affiliation(s)
- J J Ofman
- Department of Medicine and Health Services Research, Cedars Sinai Medical Center, University of California, Los Angeles, School of Medicine, USA
| | | |
Collapse
|
12
|
Wiklund I, Glise H, Jerndal P, Carlsson J, Talley NJ. Does endoscopy have a positive impact on quality of life in dyspepsia? Gastrointest Endosc 1998; 47:449-54. [PMID: 9647367 DOI: 10.1016/s0016-5107(98)70243-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND It is unclear whether normal endoscopy results in patients investigated for dyspepsia has therapeutic value. Therefore the aim of this study was to evaluate the effect of the endoscopy on quality of life and dyspeptic symptoms. METHODS One hundred ninety-six symptomatic patients (85 men and 111 women, mean age 42.9 years), who were receiving no treatment, were investigated before and 1 week after endoscopy with the use of a battery of validated questionnaires. RESULTS Before endoscopy the health-related quality of life was compromised in comparison with a normal population, but 1 week after a negative endoscopy it is increased to a level which was close to the normal range despite no major change in symptoms. Physical activity and sleep scores improved significantly after endoscopy. CONCLUSION The present results suggest that a negative endoscopy improves quality of life in the short-term in patients with dyspepsia, even though symptoms may persist.
Collapse
|
13
|
DeLuca VA, West AB, Haque S, Katz DL, Ciarolla D, Goldenberg S, Fette G. Long-term symptom patterns, endoscopic findings, and gastric histology in Helicobacter pylori-infected and -uninfected patients. J Clin Gastroenterol 1998; 26:106-12. [PMID: 9563920 DOI: 10.1097/00004836-199803000-00004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is a paucity of data on the long-term behavior of dyspepsia, endoscopic findings, and gastroduodenal histology in patients with or without Helicobacter pylori colonization. We evaluated these parameters during a period of 7 to 19 years (average, 12.3 years) by baseline and follow-up studies. In 36 patients studied, the pattern of gastroduodenal dyspepsia and esophagogastroduodenoscopy findings remained essentially unchanged in 67% and 56% respectively. Dyspepsia patterns did not correlate significantly with either endoscopic or histologic findings, including the severity or location of gastritis in the fundus or antrum, or the presence or absence of H. pylori gastritis. Of 36 patients with adequate biopsies of the fundus and antrum, H. pylori colonization with gastritis was present in 73% but not in 27%. Progression to various degrees of atrophic gastritis was noted in 100% with, and in none without, H. pylori gastritis. In the fundus, atrophy progressed from 14% to 56%, but intestinal metaplasia did not change. In the antrum, atrophy increased from 22% to 64% and intestinal metaplasia increased from 17% to 36%. No patient demonstrated dysplasia, but severe atrophy was seen in the fundus (6%) and antrum (11%). Only two patients (5%) had severe loss of glandular elements and very low pepsinogen I, and thus can be considered to have developed advanced gastric atrophy.
Collapse
Affiliation(s)
- V A DeLuca
- Department of Gastroenterology, The Griffin Hospital, Derby, Connecticut 06418, USA
| | | | | | | | | | | | | |
Collapse
|
14
|
Talley NJ, Silverstein MD, Agréus L, Nyrén O, Sonnenberg A, Holtmann G. AGA technical review: evaluation of dyspepsia. American Gastroenterological Association. Gastroenterology 1998; 114:582-95. [PMID: 9496950 DOI: 10.1016/s0016-5085(98)70542-6] [Citation(s) in RCA: 278] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- N J Talley
- Department of Medicine, University of Sydney, Nepean Hospital, Australia
| | | | | | | | | | | |
Collapse
|
15
|
Kumar S, Khannar R, Hajra B, Bose J. Psychiatric disorder in essential dyspepsia. Int J Psychiatry Clin Pract 1998; 2:41-5. [PMID: 24946246 DOI: 10.3109/13651509809115113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We wanted to examine the prevalence of psychiatric morbidity in patients diagnosed as having essential dyspepsia, as well as the short-term course of dyspeptic symptoms, following drug treatment of the psychiatric condition. Seventy-four patients with essential dyspepsia presenting to the gastroenterology outpatient department of a medical college were investigated for the presence of psychiatric disorder. The response to an open trial of pharmacotherapy in 50 patients with a psychiatric disorder and no other demonstrable pathology was assessed. These patients met the criteria for a DSM-III-R diagnosis, most commonly major depressive disorder (26) or generalized anxiety disorder (10). The mean age of those with a psychiatric disorder alone was significantly higher than that of those with another demonstrable pathology. With treatment, 16 patients with no demonstrable pathology other than psychiatric disorder (depression: 12; anxiety: 4) showed improvement over a period of 6 weeks in psychiatric as well as dyspepsia ratings. The difference was however statistically significant only for the group with major depressive disorder. We concluded that, despite differences in the characteristics of the population studied, a psychiatric diagnosis is associated with at least a proportion of cases with essential dyspepsia and emerges as a likely explanation.
Collapse
Affiliation(s)
- S Kumar
- Institute of Psychiatry, London
| | | | | | | |
Collapse
|
16
|
Speckens AE, Van Hemert AM, Bolk JH, Rooijmans HG, Hengeveld MW. Unexplained physical symptoms: outcome, utilization of medical care and associated factors. Psychol Med 1996; 26:745-752. [PMID: 8817709 DOI: 10.1017/s0033291700037764] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The aim of the study was to investigate the recovery and frequency of physician contact in patients with unexplained physical symptoms and to identify factors associated with persistent disorder. Of 100 consecutive patients who presented with medically unexplained symptoms to a general medical out-patient clinic, 81 participated in a follow-up study. The mean follow-up time was 15.2 months (S.D. 4.0). At follow-up, many of the patients with unexplained physical symptoms reported that they had recovered (30%) or improved (46%) with regard to their presenting symptoms. Female sex and a high number of symptoms predicted a bad outcome in terms of recovery. Persistence of symptoms was not related to the duration of the symptoms, type of presenting complaint or the presence of psychiatric disorder. Forty per cent of patients with unexplained symptoms did not visit their general practitioner on their own initiative in the year following the initial visit to the clinic. Medical care utilization appeared to be associated with female sex, age, number and duration of symptoms, fatigue and psychiatric disorder, especially somatoform disorders. However, the association of a high frequency of physician contact with female sex and psychiatric disorder was not sustained after controlling for possible confounding factors.
Collapse
Affiliation(s)
- A E Speckens
- Department of Psychiatry, University Hospital Leiden, The Netherlands
| | | | | | | | | |
Collapse
|