Endoscopic Over Diagnosis Of Chronic Gastritis In China And Impact On Patient's Outcome

Backgrounds and aimsDyspepsia is a common clinical disease,with a high incidence around the word.Although most of the dyspepsia is not of life-threatening,it do decrease the patients'health-related quality of life compared with healthy controls.Besides,because of the recurrent dyspepsia symptoms,repeated medical consulting and examination,variety of medical therapy are very common among dyspepsia patients which would definitely cause severe economic burden of patients and bring a serious challenge to social medical resources.Upper gastrointestinal endoscopy plays an important role in the diagnosis of endoscopy.However,few of organic disease would be found among the large number of endoscopies,especially in countries where put gastroscopy as routine examination.For these patients,most of them were diagnosed as chronic gastritis.However,is this diagnosis reasonable for patients with no obvious structural abnormality under endoscopy still remain controversial.The facts and effects of this problem from both physician's and patient's perspectives were seldom reported.So we composes an online survey for gastrointestinal specialist and a prospective case-controlled study for patients taking upper gastrointestinal endoscopy,to understand the physician's attitude and evaluate its clinical significance.Patients and MethodsThis study contained an online survey for physicians and a prospective case-controlled study for patients with upper gastrointestinal symptoms.The survey part was to evaluate physician's perspective of endoscopic diagnosis of Chronic Gastritis.The prospective part was to evaluate the impact of over-diagnosis on patient's outcome.Patients who consulted because of dyspepsia symptoms at Gastroenterology Clinic of Shandong University Qilu Hospital during July 2016 and November 2016 and experienced gastroscopy with no obvious abnormalities were included in this study.All the gastroscopy were performed by one experienced endoscopic physician,and he would give the diagnosis of "normal gastric mucosa" or "non-atrophic gastritis"randomly based on random number table.Another doctor who was blinded by the gastroscopy reports collected the subjects' demographic data and assessed their symptom severity(Gastrointestinal Symptom Score,GIS),health-related quality of life(Short-Form of Nepean Dyspepsia Index,SF-NDI)and mental status(Hamilton Anxiety Scale,HAMA)by validated questionnaires after the endoscopic procedure immediately and conducted a telephone follow-up at the week 2,week 4 and week 8 after the endoscopy used the same questionnaire to evaluate the change.The information of treatment of provided by prescriptions or OTCs and the direct medical costs were also recorded.ResultsA total of 38 physicians participated into the online survey.Most of the surveyed physicians admitted the over diagnosis of chronic gastritis(25/38)and believed correction with more normal report would benefit the patients(26/38).Total of 60 patients involved in the prospective study,32 were distributed to normal group and the other 28 were in gastritis group.No statistical differences of the demographic data between the two groups were found(p>0.05).Four subjects in normal group and 5 in gastritis group respectively didn't complete the follow-up.The most common complain were bloating(31.6%),abdominal pain(21.7%)and sickness(21.7%).The duration of the discomfort time varied from 1 month to 20 years,symptoms last for six month to 3 years were most common(40%).About 68%of patients had experienced gastroscopy exam in the past years.In normal group,the score of GIS and SF-NDI in week 2,week4 and week 8 were decreased significantly compared with basic score(p<0.05).The results in gastritis group were similar with normal group(p<0.05).The HAMA score in both two groups in week 8 were also decreased significantly than basic score(p=0.000 vs p=0.032).When compared the two groups at the same time,there were no statistically significant differences of the scores of GIS,SF-NDI and HAMA between the two groups(p>0.05).In the aspect of prescriptions,no statistical differences between the two groups(p>0.05).However,when compared the actual use of medicine between the two groups,more drugs were consumed in gastritis group and the difference was statistically significant(p=0.047).The mean costs in normal group were ?772,and in gastritis group were ?859,but the difference was not significant(p=0.158).ConclusionsAs most of surveyed physicians realized the over diagnosis of chronic gastritis,the diagnosis itself seems not to be an influential factor on treatment and outcome.