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December 16, 2018  
HEARTBURN NEWS: Feature Story

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    Physicians Show Bias When Diagnosing Stomach Problems


    July 15, 2014

    Source: Mayo Clinic

    Patients who complain of upper gastrointestinal (GI) symptoms often face a diagnosis of either gastroesophageal reflux disease (
    GERD) or functional dyspepsia. Because the two conditions often overlap, it can be difficult to distinguish between them and diagnose them properly. Yet ambulatory care facilities and hospitals have reported a dramatic increase in the number of GERD-related visits/discharges in recent years. 

    This led a team of researchers at Mayo Clinic, others from the United States, Europe and Australia to question if "observer bias" plays a role in the diagnosis of GERD, compared to a diagnosis of functional dyspepsia. As reported during the American College of Gastroenterology 2011 Annual Scientific Meeting and Postgraduate Course, such a bias exists and increases the likelihood of a diagnosis of GERD. This theory is supported by the following findings from the study:

    • In the last 20 years, the number of GERD diagnoses has increased despite a simultaneous decrease in GERD symptoms.
    • In the presence of both functional dyspepsia and GERD symptoms, GERD is diagnosed most commonly.
    • GERD is the most likely diagnosis in the presence of functional dyspepsia symptoms only.
    "These findings serve as a reminder to all physicians to keep an open mind when patients complain of upper GI pain," says senior author G. Richard Locke, M.D., a Mayo Clinic gastroenterologist. "It is worth considering every possible cause of the symptoms, including the sometimes challenging-to-treat functional dyspepsia. Plus, if we believe the patient's symptoms are caused by GERD, we must confirm that diagnosis." 

    The study also found that:
    • Between 1985 and 2009, diagnosis rates of GERD rose from 325 per 100,000 patients to 1,866.
    • Symptom reporting for GERD actually decreased from 12 percent during the period from 1988 to 1994, to 7.6 percent in 2008-2009.
    • Overall functional dyspepsia diagnosis rates rose from 45 in 1985 to 964 in 1999, yet decreased to 452 between 1999 and 2009.
    • Functional dyspepsia symptom reporting was stable at around 5 percent throughout the various survey periods.
    • The chance of receiving a GERD diagnosis when reporting GERD symptoms was 63 percent, while the chance of receiving an functional dyspepsia diagnosis when reporting functional dyspepsia symptoms was 12.5 percent.
    • Forty-five percent of subjects reporting both GERD and functional dyspepsia symptoms were diagnosed with GERD only.
    • Fifty percent of subjects reporting functional dyspepsia symptoms only were diagnosed with both GERD and functional dyspepsia.
    Discuss in the Reflux1 forums

    Photo: Vic

    Last updated: 15-Jul-14

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