YIELD OF ULTRASONOGRAPHY IN PAKISTANI PATIENTS WITH EPIGASTRIC PAIN SYNDROME-LIKE DYSPEPSIA

Abstract

Background: In Pakistan, upto 23% of patients initially presenting to a gastroenterologist, do so with chronic dyspepsia. Cost constraints limit the scope of evaluation in this developing country.

Objectives: To determine the yield of routine ultrasonography noninvasive testing in patients with epigastric pain syndrome-like chronic dyspepsia in Karachi, Pakistan.

Methods: Adult patients (aged 18-49) with intermittent epigastric pain or burning for greater than 6 months were prospectively enrolled in the study. Patients with alarm symptoms, NSAID use, and those with predominately postparandial symptoms were excluded. The following investigations were done: LFTs, HBsAg, HCV antibody, ESR, TTG IgA, Helicobacter pylori antibody, amylase, and an abdominal ultrasound.

Results: 1000 patients with chronic dyspepsia were enrolled. The average age was 37 years.  59% were female and 41% were male. Associated symptoms were nausea (43%), vomiting (24%), heartburn (63%), and bloating (17%). Abdominal ultrasonography was normal in 74%; 19% had a fatty liver on ultrasound and 6% had gallbladder stones or polyps. LFTs were normal in 86%. Hepatitis B and C testing were positive in 10% of patients, each. 64% had a positive H. pylori serology. 

Conclusions: In Pakistani patients with epigastric pain syndrome-like dyspepsia, the yield of noninvasive testing is low, except for H. pylori testing. 64% of patients were H. pylori positive. Ultrasonography was normal in 74% of patients. Further studies are needed to evaluate the cost effectiveness of different tests, and the yield of endoscopy in this patient population.