• 23
    Dec
  • DYSPEPSIA IN AFRICAN-AMERICAN AND HISPANIC PATIENTS: DISCUSSION

endoscopy

Previous studies on dyspepsia did not report their results by race/ethnicity. Therefore, investigating dyspepsia in African-American and Hispanic populations is a distinctive characteristic of our study. We focused on the etiology of dyspepsia in relation to age and alarm features among African-American and Hispanic patients. Our study indicated that the presence of alarm features in our minority population is associated with the presence of underlying lesions. This concurs with what other researchers have found.

Esophagitis, duodenal ulcer, and gastric ulcer were the causes of dyspepsia in 13%, 13%, and 11% of cases, respectively. This is in accordance with the results reported by Heikkinen et al., who studied the etiology of dyspepsia in 400 unselected consecutive patients in general practice. The incidence of gastric and esophageal carcinoma was higher in our patients (3%) when compared with the Heikkinen et al. study (2%). This observation may be relevant, since many of our patients do not have the benefits of appropriate health education, timely preventive care, and medical intervention. A high index of suspicion for gastric malignancy in dyspeptic patients and a low threshold for endoscopic evaluation, especially in the presence of one or more alarm features, may result in early diagnosis and improved survival. Injudicious use of acid suppression therapy in such patients may delay the diagnosis and worsen the prognosis.
Tests for H. pylori were done in only 278 (41%) of our patients, of whom 125 (45%) were positive. The reason that fewer patients had H. pylori tests in our study may be the lack of awareness and/or lack of availability of the tests during an earlier part of the study. Previous studies have reported an overall prevalence of H. pylori around 32-35% that increased to 41-57% in those aged 70-85 years. The prevalence of H. pylori in our study is higher than the overall reported prevalence of 35%, and it is in agreement with the study that showed a high prevalence among the minority population. Lower socioeconomic status, overcrowded living, lack of health education, or other yet unidentified factors may be responsible for this discrepancy. H. pylori infection is present in approximately 90% of patients with duodenal ulcers and 70-90% of patients with gastric ulcers. However, the association of К pylori and nonulcer dyspepsia is not very clear. Several studies on the treatment of H. pylori in dyspepsia have shown conflicting results. Blum et al. Kosken-pato et al., and several others have done studies showing no benefit of H. pyton-eradication therapy in relieving the symptoms or improving the quality of life. However, studies by McNamara et al., Bruley Des Varannes et al. support К pylori eradication in symptomatic patients with nonulcer dyspepsia. In our study, there was evidence of symptomatic improvement of dyspepsia in about one-third of H. The influence of this treatment on long-term outcome remained undetermined.

Eleven of 21 (52%) patients with cancer of the stomach in our study were positive for H. pylori. Uemura et al., in their eight-year follow-up of 1,246 H. pylori positive Japanese patients with nonulcer dyspepsia, found a 4.7% incidence of gastric cancer.
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Precise comparison of our results with other studies is difficult due to differences in study design and population characteristics. Our study concurred with the time-honored observation that endoscopy is superior to radiological studies in evaluation of dyspepsia. Endoscopy is not only the most accurate diagnostic tool, it also has a positive impact on one’s quality of life with dyspepsia and results in higher patient satisfaction. Initial endoscopy might be a cost-effective intervention in dyspeptic patients over 50 years of age.

Although our study has the strength of availability of endoscopic results in a significant number of African-American and Hispanic patients with dyspepsia, it has some important limitations. Firstly, the retrospective cross-sectional design limited our ability to collect clinical data in a standardized fashion. Secondly, our investigated patients were from a teaching community hospital, and data thus obtained may not be applicable to unselected dyspeptics from the population at large. In spite of these limitations, our findings, such as the importance of alarm features as predictors of underlying organic lesions and the value of early endoscopy, are noteworthy. In the future, prospective controlled studies in minority patients with dyspepsia are needed to elaborate upon its natural history and the impact of early endoscopy. Ultimately, the goal is to improve therapeutic outcomes in dyspeptic minority patients. buy levitra uk

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