Web-based patient education cuts down upper GI endoscopy for dyspepsia

Reuters Health - 05/05/2021  - Patients with uninvestigated dyspepsia may be less likely to require an upper gastrointestinal tract endoscopy if they participate in web-based patient education, a small clinical trial suggests.

Researchers followed 119 patients with uninvestigated symptoms of dyspepsia who had been referred by general practitioners for an upper gastrointestinal (GI) tract endoscopy without prior consultation with a gastroenterologist. Patients were randomized 1:1 to participate in the educational intervention or a control group that proceeded with the upper GI tract endoscopy referral without receiving education.

Significantly fewer patients in the intervention group (39%) than the control group (82%) underwent the upper GI tract endoscopy (relative risk 0.46).

"We believe that educating patients on dyspepsia helps them to understand the origin and mechanism of their symptoms," said lead study author Dr. Judith de Jong of the department of gastroenterology and hepatology at Radboud University Medical Center in Nijmegen, the Netherlands.

"This understanding then facilitates management of the dyspepsia and reassures patients of the benign nature of the symptoms," Dr. de Jong said by email.

Participants assigned to the intervention were provided a link to a web-based educational program and asked to complete this at home before scheduling an upper GI tract endoscopy.

All participants in the study were allowed to schedule the endoscopy at any time.

A total of 9 patients randomized to the education intervention didn't complete it, and 5 of these individuals subsequently underwent the upper GI tract endoscopy, researchers report in JAMA Internal Medicine.

Lower rates of endoscopy were seen at 12 and 52 weeks, and researchers calculated that five patients needed to receive the education program to prevent one endoscopy.

Among those who did undergo endoscopy, researchers most often identified no abnormality in patients who were on proton pump inhibitors (PPIs) in both the education group (46%) and the control group (47%).

In the education group, endoscopy resulted in clinically relevant findings for two people on PPIs (8%) and two people not on the drugs. In the control group, endoscopy resulted in clinically relevant findings for four patients on PPIs (9%) and two patients (4%) not on PPIs.

Clinically relevant findings included helicobacter pylori associated gastritis, reflux esophagitis, Barrett esophagus, and gastric ulcer.

One limitation of the study is that researchers failed to enroll their target sample size due to recruitment issues, the study team notes. It's possible that higher inclusion rates might have occurred if patients had been offered the opportunity to participate in primary care, instead of waiting until their referral for endoscopy, they point out.

Even so, the study underscores that endoscopy may not always be necessary, and that it may be avoided with education, said Dr. Colleen Parker of the division of gastroenterology and hepatology at the University of Toronto.

"This study highlights that, in the absence of red flag symptoms, dyspepsia typically follows a benign course," Dr. Parker, who wasn't involved in the study, said by email. "By using standardized materials to educate patients it can ultimately help patient symptoms, improve quality of life for patients, and reduce unnecessary procedures."

SOURCE: https://bit.ly/3eTMkTL JAMA Internal Medicine, online April 26, 2021.

By Lisa Rapaport



Posted on 5 May 202111 May 2021