Education for patients reduced upper GI endoscopies for uninvestigated dyspepsia
To reduce overuse, a Dutch trial provided a self-managed, web-based educational intervention containing information on gastric function, dyspepsia, and upper GI tract endoscopy to some patients referred for the procedure by their primary care clinicians.
An educational intervention for patients successfully reduced use of upper GI tract endoscopy for uninvestigated dyspepsia, a recent trial found.
The trial, conducted at four teaching hospitals in the Netherlands, included patients ages 18 to 69 years with uninvestigated dyspeptic symptoms who were referred for upper GI tract endoscopy by their general health care clinician without prior consultation of a gastroenterologist. Patients were excluded if they had red-flag symptoms, such as signs of upper GI tract hemorrhage, unintentional weight loss of 5% or more, persistent vomiting, dysphagia, or jaundice. Results were published by JAMA Internal Medicine on April 26.
A total of 119 patients (median age, 48 years; 40% men) were randomized to receive either the endoscopy (n=57) or a self-managed, web-based educational intervention containing information on gastric function, dyspepsia, and upper GI tract endoscopy (n=62). Within 12 weeks of the intervention, significantly fewer intervention-group patients had undergone upper GI tract endoscopy: 24 (39%) versus 47 (82%) in the control group (relative risk, 0.46; 95% CI, 0.33 to 0.64; P<0.001). The two groups showed similar improvements in symptom severity and quality of life. One additional patient in the intervention group required upper GI tract endoscopy in the year after randomization.
The authors noted that many previous efforts to reduce unnecessary use of upper GI tract endoscopy have been focused on physicians. “Our study fills this hiatus by targeting the patients' gap in knowledge and misconceptions about upper GI tract disease,” they wrote. However, physicians' perspectives contributed to one of the limitations of the trial, its small size. “In selecting patients for this study, we were consistently met with resistance from patients as well as the referring clinicians, who favored the original diagnostic track rather than randomization for this trial,” the authors wrote, suggesting parallel education of clinicians as a potential partial solution to this challenge.
Based on the study's results, they concluded that the educational tool appeared to be effective. “We advocate the implementation of an online accessible patient education platform for dyspepsia management, in both primary and secondary care, to further decrease overuse of health care. Future studies should focus on the long-term outcomes of reducing upper GI tract endoscopy use through patient education,” the authors wrote.