Value of the unaided clinical diagnosis in dyspeptic patients in primary care

OBJECTIVES: Attempts to establish a clinical diagnosis in dyspeptic patients have generally been unrewarding. However, studies in unselected dyspeptic patients are lacking. The aim of this study was to determine the value of the unaided clinical diagnosis by general practitioners (GP) and by experienced gastroenterologists (GA) in unselected dyspeptic patients in primary care. METHODS: Three hundred forty-seven patients with epigastric pain/discomfort for more than 2 wk who were consulting general practitioners (n = 73), but without alarm symptoms. GPs and GAs gave a provisional diagnosis based on an unstructured interview. All patients underwent endoscopy within 5 days of referral. Validity of the provisional diagnoses was measured using the endoscopic diagnoses as the gold standards. RESULTS: For GPs, the sensitivity of a provisional diagnosis of peptic ulcer was 61[95CI): 46-74; for specificity 73 the 958-78 and for positive predictive values, it was 28 the 950-37 leading to a higher specificity: 8495 79-88, but a similar sensitivity: 5595 40-69. The GPs were unable to distinguish between functional and organic dyspepsia (chance-corrected overall validity: 9 95 0-18. GPs and GAs agreed in their provisional diagnosis in only 45 in whom the diagnosis was confirmed by endoscopy in 2/3. CONCLUSION: The unaided clinical diagnosis given by the GP and by the GA in dyspeptic patients in primary care is unreliable. Nearly half of patients with ulcer or esophagitis were misclassified, despite a high susceptibility to organic disease. Different patients were problematic for GPs and GAs, which may indicate that most dyspeptic patients do not present with symptoms characteristic of a specific disease. (C) 2001 by Am. Cell. of Gastroenterology

Thermogenic effects of commercially available plant preparations aimed at treating human obesity.

Different commercially available plant preparations have been claimed to have anti-obesity action. We investigated the acute effects of oral administration of 12 of these preparations in non-obese women and men. No significant increase in energy expenditure (EE) has been noted after treatment with any of these preparations. No change in respiratory quotient (RQ) was shown, except after treatment with maté (Ilex paraguariensis) extract, where a drop in RQ was observed, indicating a rise in the proportion of fat oxidized. The results suggested the poor potential of these plant preparations in the treatment of obesity, except possibly for the maté extract. Further studies are required to explore the influence of higher dosages of these preparations as well as chronic administration in man