Self care and primary care of dyspepsia

The prevalence and pattern of dyspeptic symptoms in the community are described in population-based epidemiological studies. The six month period prevalence of dyspepsia is 41% age, but not gender, social class or geography, is linked to symptom frequency. Symptoms of upper abdominal pain and heartburn are often experienced by the same individual. Self care is of great importance; only one quarter of symptomatic subjects seek medical advice. Factors related to the decision to consult include social class, the identity of the general practitioner concerned and recent experience of adverse life events. Although symptom frequency and severity also play a part, the most important determinants of consultation are the beliefs and concerns of patients about their symptoms. General practitioners' use of, and response, to the findings of endoscopy in the evaluation of dyspepsia varies widely, evidenced in a description of an open-access endoscopy service and a study of patients with endoscopy-negative dyspepsia. This variation is described and explored more fully in a study of referral, investigation and prescribing patterns of 245 general practitioners working in one health district, which emphasizes the problems of explaining this variation and suggests that decisions about the use of these services are often idiosyncratic. Decision making studies of general practitioners' management of dyspepsia show that GPs have widely different information needs and, by implication, knowledge bases, confirmed by the demonstration of a range of beliefs about the natural history and management of dyspeptic conditions. Uncertainty about these issues may account for some of the wide variation in behaviour observed.