A systematic review 1 including 18 studies with a total of 13,751 subjects was abstracted in DARE. When the primary care physician, specialist or computer assessed the patient as having organic dyspepsia, the pooled LR was 1.6 (95% CI: 1.4, 1.8). When the primary care physician, specialist or computer assessed the patient as having functional dyspepsia, the pooled LR was 0.46 (95% CI: 0.38, 0.55). The pooled DOR was 4.0 (95% CI: 2.8, 5.7; heterogeneity, chi-squared 190, P<0.001). In the diagnosis of peptic ulcer disease, the pooled positive LR for primary care physicians was 2.2 (95% CI: 1.8, 2.5; heterogeneity, P=0.95) and the negative LR was 0.63 (95% CI: 0.51, 0.79; heterogeneity, P=0.10). Based on 4 studies, the pooled positive LR for specialists was 2.9 (95% CI: 2.1, 4.0; heterogeneity, P<0.001) and the negative LR was 0.48 (95% CI: 0.43, 0.52; heterogeneity, P=0.72). Based on the results of 6 studies, the pooled positive LR for computer models was 1.9 (95% CI: 1.6, 2.3; heterogeneity, P<0.001) and the negative LR was 0.34 (95% CI: 0.25, 0.47; heterogeneity, P<0.001). When the results of all three methods of diagnosis were combined, the pooled positive LR was 2.2 (95% CI: 1.9, 2.6) and the negative LR was 0.45 (95% CI: 0.38, 0.53). The pooled DOR was 5.2 (95% CI: 0.38, 7.2; heterogeneity, chi-squared 56, P<0.001). For the diagnosis of esophagitis, the pooled positive LR for primary care physicians was 2.3 (95% CI: 1.6, 3.2; heterogeneity, P<0.001) and the negative LR was 0.58 (95% CI: 0.43, 0.79). Based on 4 studies, the pooled positive LR for gastroenterologists was 4.5 (95% CI: 2.3, 8.9) and the negative LR was 0.48, (95% CI, 0.35, 0.65). Based on 7 studies, the pooled positive LR for computer models was 1.7 (95% CI: 1.5, 2.1) and the negative LR was 0.48 (95% CI: 0.36, 0.63). When the data for all three methods of diagnosis were combined, the pooled positive LR was 2.4 (95% CI: 1.9, 3.0) and the negative LR was 0.50 (95% CI: 0.42, 0.60). The pooled DOR for clinical opinion alone was 6.7 (95% CI: 3.7, 12.0; heterogeneity, chi-squared 76, P<0.001).
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity of results). The authors stated that clinical history is still important in patients presenting with dyspepsia, not only to determine the location of the epigastric pain or discomfort, but also to establish that history does not suggest other disorders. In addition, the reason for consultation should be considered so that any concerns the patient may have about possible ischaemic heart disease or cancer can be dealt with.
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