Dispepsia: necesidad de una guía de práctica clínica para su evaluación en la atención primaria de salud
Palabras clave:
DISPEPSIA, DISPEPSIA ORGÃNICA, DISPEPSIA FUNCIONAL/ diagnóstico, tratamientoResumen
La dispepsia es un motivo de consulta frecuente en la atención primaria de salud (APS). Se estima que su prevalencia en la población general sobrepasa el 50%. En el manejo inicial del paciente con dispepsia se requiere una valoración que contemple el equilibrio, entre la necesidad de conocer la etiología, la realización de pruebas diagnósticas y/o la derivación al especialista de gastroenterología. Es precisamente en este momento que surgen múltiples y disímiles estrategias para enfrentarla, por parte de los médicos de la APS. El objetivo del presente trabajo es proponer un conjunto de recomendaciones, avaladas en una amplia revisión de la literatura, para guiar a los profesionales y a los pacientes en el proceso de toma de decisiones sobre cuáles intervenciones sanitarias son más adecuadas en el abordaje de esta condición clínica específica.Descargas
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1. Talley NJ, Stanghellini V, Heading RC, Koch KL, Malagelada JR, Tytgat GN. Functional gastroduodenal disorders. Gut. 1999; 45 (Supl. 2): 37-42.
2. Institute for Clinical Systems Improvement. Health Care Guideline: Dyspepsia.(Monografía en Internet) Institute for Clinical Systems Improvement, 2002. (Citado 20 Feb 2007) Disponible en: http://www.icsi.org/guide/Dyspep.pdf
3. Aymerich M, Baena JM, Boix C, Carrillo R, Madrilejos R, Mascort JJ et al. Direcció clínica en l’atenció primària. Dispepsia - H. pylori. Guies de pràctica clínica i material docent. (Monografía en Internet) 2005 (citado 20 Feb 2007). Disponible en: http://www.gencat.net/ics/professionals/guies/dispepsia/dispepsia.htm
4. Agreus L. Natural history of dyspepsia. Gut. 2002; 50 (Supl. 4): 2-9.
5. Grupo de trabajo de la guía de práctica clínica sobre ERGE. Manejo del paciente con enfermedad por reflujo gastroesofágico (ERGE). Guía de práctica clínica. (en Internet) Barcelona: Asociación Española de Gastroenterología, Sociedad Española de Medicina de Familia y Comunitaria y Centro Cochrane Iberoamericano; 2001. Programa de Elaboración de Guías de Práctica Clínica en Enfermedades Digestivas, desde la Atención Primaria a la Especializada: 1. (citado 20 Feb 2007).Disponible en: http://www.guiasgastro.net
6. Veldhuyzen van Zanten SJO, Flook N, Chiba N, Armstrong D, Barkun A, Bradette Metal, for the Canadian Dyspepsia Working Group. An evidence-based approach to the management of uninvestigated dyspepsia in the era of Helicobacter pylori. CMAJ. 2000; 162 (Supl. 12): 3-23.
7. Kellow JE. Organic causes of dyspepsia, and discriminating functional from organic dyspepsia. Best Pract Res Clin Gastroenterol 2001; 15: 477-487.
8. Heading RC. Prevalence of upper gastrointestinal symptoms in the general population: a systematic review. Scand J Gastroenterol. 1999; 231(Suppl): 3-8.
9. SBU - The Swedish Council on Technology Assessment in Health Care. Stomach pain -evidence-based methods in the diagnosis and treatment of dyspepsia. Stockholm; 2000.
10. Stanghellini V. Three-month prevalence rates of gastrointestinal symptoms and the influence of demographic factors: results from the Domestic International Gastroenterology Surveillance Study (DIGEST). Scand J Gastroenterol. 1999; 231(Suppl): 20-28.
11. Caballero Plasencia AM, Sofos Kontoyannis S, Martín Ruiz JL, Valenzuela Barranco M. La prevalencia de la dispepsia en España. Med Clin. (Barc) 1994; 103: 717.
12. Schwartz MD. Dyspepsia, peptic ulcer disease, and esophageal reflux disease. West J Med. 2002; 176: 98-103.
13. Turabian JL, Gutiérrez V. Variaciones en la frecuencia de las enfermedades crónicas y los factores de riesgo en atención primaria: 1985-1995. Atenc Primaria. 1996; 18: 65-69.
14. Talley NJ. Dyspepsia: management guidelines for the millennium. Gut. 2002; 50 (Supl.4): 72-78.
15. Bazaldua OV, Schneider FD. Evaluation and management of dyspepsia. Am Fam Physician. 1999; 60: 1.773-1.788.
16. Haycox A, Einarson T, Eggleston A. The health economic impact of upper gastrointestinal symptoms in the general population: results from the Domestic/International Gastroenterology Surveillance Study (DIGEST). Scand J Gastroenterol. 1999; 231(Suppl): 38-47.
17. Talley NJ, Silverstein MD, Agreus L, Nyren O, Sonnenberg A, Holtmann G. AGA technical review: evaluation of dyspepsia. Gastroenterology. 1998; 114: 582-595.
18. Fisher RS, Parkman HP. Management of non ulcer dyspepsia. N Engl J Med. 1998; 339: 1.376-1.381.
19. Barenys M, Abad A, Pons JM, Moreno V, Rota R, Granados A et al. Scoring system has better discriminative value than Helicobacter pylori testing in patients with dyspepsia in a setting with high prevalence of infection. Eur J Gastroenterol Hepatol. 2000; 12: 1.275-1.282.
20. Ferlay J, Bray F, Pisani P, Parkin DM. GLOBOCAN 2000: cancer incidence, mortality and prevalence worldwide, Version 1.0.IARC Cancer Base n.º 5. (Homepage en Internet) Lyon, IARC Press, 2001. (actualizado 03 Feb 2001; citado 20 Feb 2007). Disponible en: http://www-dep.iarc.fr/globocan/globocan.htm.
21. Moayyedi P, Mason J. Clinical and economic consequences of dyspepsia in the community. Gut. 2002; 50 (Supl. 4): 10-12.
22. Ruiz M, Vilasante F, León F, González-Lara V, González C, Crespo M et al. Cuestionario sobre calidad de vida asociada a dispepsia. Adaptación española y validación del cuestionario Dyspepsia Related Health Scale. Med Clin (Barc). 2001; 117: 567-573.
23. Enck P, Dubois D, Marquis P. Quality of life in patients with upper gastrointestinal symptoms: results from the Domestic/International Gastroenterology Surveillance Study (DIGEST). Scand J Gastroenterol. 1999; 231(Suppl): 48-54.
24. Olden KW. Are psychosocial factors of aetiological importance in functional dyspepsia? Baillieres Clin Gastroenterol. 1998; 12: 557-571.
25. Olden KW, Drossman DA. Psychologic and psychiatric aspects of gastrointestinal disease. Med Clin North Am. 2000; 84: 1.313-1.327.
26. Kay L, Jorgensen T. Epidemiology of upper dyspepsia in random population. Prevalence, incidence, natural history and risk factors. Scan J Gastroenterol. 1994; 29: 1-7.
27. Yuyuan LI, Yuqiang NIE, Weihong SHA, Hua SU. The link between social psychosocial and functional dyspepsia: An epidemiological study. Chin Med J. 2002; 115: 1.082-1.084.
28. Stanghellini V. Relationship between upper gastrointestinal symptoms and lifestyle, psychosocial factors and comorbidity in the general population: results from the Domestic/International Gastroenterology Surveillance Study (DIGEST). Scand J Gastroenterol. 1999; 231(Suppl): 29-37.
29. Pantoflickova D, Blum AL, Koelz HR. Helicobacter pylori and functional dyspepsia: a real causal link? Bailleres Clin Gastroenterol. 1998; 12: 503-532.
30. Danesh J, Lawrence M, Murphy M, Roberts S, Collins R. Systematic review of the epidemiological evidence on Helicobacter pylori infection and nonulcer or uninvestigated dyspepsia. Arch Intern Med. 2000; 160: 1.192-1.198.
31. Bazzoli F, De Luca L, Pozzato P, Zagari RM, Fossi S, Ricciardiello L et al. Helicobacter pylori and functional dyspepsia: review of previous studies and commentary on new data. Gut. 2002; 50 (Supl. 4): 33-35.
32. Elta GH, Behler EM, Colturi TJ. Comparison of coffee intake and coffee-induced symptoms in patients with duodenal ulcer, nonulcer dyspepsia, and normal controls. Am J Gastroenterol. 1990; 85: 1.339-1.342.
33. Nandurkar S, Talley NJ, Xia H, Mitchell H., Hazel S, Jones M. Dyspepsia in the community is linked to smoking and aspirin use but not to Helicobacter pylori infection. Arch Intern Med. 1998; 158: 1.427-1.433.
34. Woodward M, Morrison CE, McColl Ke. The prevalence of dyspepsia and use of antisecretory medicatioin in North Gasgow: role of Helicobacter pylori vs lifestyle factors. Aliment Pharmacol. 1999; 13: 1.505-1.509.
35. Bytzer P, Howell S, Leemon M, Young LJ, Jones MP, Talley NJ. Low socioeconomic class is a risk factor for upper and lower gastrointestinal symptoms: a population based study in 15000 Australian adults. Gut. 2001; 49: 66-67.
36. Talley NJ, Weaver AL, Zinsmeister AR. Smoking, alcohol, and nonsteroidal anti-inflammatory drugs in outpatients with functional dyspepsia and among dyspepsia subgroups. Am J Gastroenterol. 1994; 89: 524-528.
37. Talley NJ, McNeilD. Piper DW. Environmental factors and chronic unexplained dyspepsia. Association with acetaminophen but not other analgesics, alcohol, coffee, tea, or smoking. Dig Dis Sci. 1988; 33: 641-648.
38. Kurata JH, Nogawa AN. Meta-analysis of risk factors for peptic ulcer. Nonsteroidal anti-inflammatory drugs, Helicobacter pylori, and smoking. J Clin Gastroenterol. 1997; 24: 2-17.
39. Huang JQ, Sridhar S, Hunt RH. Role of Helicobacter pylori infection and non-steroidal anti-inflammatory drugs in peptic-ulcer disease: a meta-analysis. Lancet. 2002; 359: 14-22.
40. Chan FK, To KF, Wu JC, Yung MY, Leung WK, Kwok T et al. Eradication of Helicobacter pylori and risk of peptic ulcers in patients starting long-term treatment with non-steroidal anti-inflammatory drugs: a randomised trial. Lancet. 2002; 359: 9-13.
41. Straus WL, Ofman JJ, MacLean C, Morton S, Berger ML, Roth EA et al. Do NSAIDs cause dyspepsia? A meta-analysis evaluating alternative dyspepsia definitions. Am J Gastroentrol. 2002; 97: 1.951-1.958.
42. Aalykke C, Lauritsen K. Epidemiology of NSAID-related gastroduodenal mucosal injury. Best Pract Res Clin Gastroenterol. 2001; 15: 705-722.
43. The National Prescribing Center. Managing dyspepsia: the role of Helicobacter pylori. MeReC Bulletin. 2001; 12 (1): 1-4.
44. Moayyedi P, Axon AT, Feltbower R, Duffett S, Crocombe W, Braunholtz D et al. Relation of adult lifestiles and socioeconomic factors to the prevalence of Helicobacter pylori infection. Int J Epidemiol. 2002; 31: 624-631.
45. Goodwin RD, Murray BS. Generalized Anxiety disorder and peptic ulcer disease among adults in the United States. Psychosomatic Medicine. 2002; 64: 862-866.
46. Andersen IB, Jorgensen T, Bonnevie O, Gronbaek M, Sorensen TI. Smoking and alcohol intake as risk factors for bleeding and perforated peptic ulcers: a population-based cohort study. Epidemiology. 2000; 11: 434-439.
47. International Agency for Research on Cancer. Infection with Helicobacter pylori. IARC Monogr Eval Carcinog Risks Hum. 1994; 61: 177-240.
48. Correa P. Gastric neoplasia. Curr Gastroenterol Rep. 2002; 4: 463-470.
49. Madsen LG, Bytzer P. The value of alarm features in identifying organic causes of dyspepsia. Can J Gastroenterol. 2000; 14: 713-720.
50. American Gastroenterological Association medical position statement: evaluation of dyspepsia. Gastroenterology. 1998; 114: 579_581.
51. Malfertheiner P, Megraud F, O'Morain C, Hungin AP, Jones R, Axon A et al. The European Helicobacter Pylori Study Group (EHPSG). Current concepts in the management of Helicobacter pylori infection -the Maastricht 2-2000. Consensus Report. Aliment Pharmacol Ther. 2002; 16: 167-180.
52. Numans ME, Van der Graaf Y, de Wit NJ, Touw-Otten F, de Melker RA. How much ulcer is ulcer-like? Diagnostic determinants of peptic ulcer in open access gastroscopy. Fam Pract. 1994; 11: 382-388.
53. Johannessen T, Petersen H, Kleveland PM, Dybdahl JH, Sandvik AK, Brenna E et al. The predictive value of history in dyspepsia. Scand J Gastroenterol. 1990; 25: 689-697.
54. Barenys M, Rota R, Moreno V, Villafafila R, García-Bayo I, Abad A et al. Validación prospectiva de un modelo clínico predictivo de dispepsia orgánica en el ámbito de la atención primaria y de las consultas de gastroenterología (Abstract). Gastroenterol Hepatol. 2003; 26 (2): 103.
55. Adang RP, Ambergen AW, Talmon JL, Hasman A, Vismans JF, Stockbrugger RW. The discriminative value of patient characteristics and dyspeptic symptoms for upper gastrointestinal endoscopic findings: a study on the clinical presentation of 1,147 patients. Digestion. 1996; 57: 118-134.
56. Buckley MJ, Scanlon C, McGurgan P, O´Morain CA. A validated dyspepsia symptom score. Ital J Gastroenterol Hepatol. 1997; 29: 495-500.
57. Mendall MA, Jazrawi RP, Marrero JM, Molineaux N, Levi J, Maxwell JD et al. Serology for Helicobacter pylori compared with symptom questionnaires in screening before direct access endoscopy. Gut. 1995; 36: 330-333.
58. Bytzer P, Hansen JM, Schaffalitzky de Muckadell OB, Malchow-Moller A. Predicting endoscopic diagnosis in the dyspeptic patient. The value of predictive score models. Scand J Gastroenterol. 1997; 32: 118-125.
59. Coelho-Filho JM, Lima JW, Furtado GB, Castelo A. Development of a strategy to optimize the indications for the upper gastrointestinal endoscopy in patients with dyspepsia at the primary care level. Rev Assoc Med Bras. 2000; 46: 30-38.
2. Institute for Clinical Systems Improvement. Health Care Guideline: Dyspepsia.(Monografía en Internet) Institute for Clinical Systems Improvement, 2002. (Citado 20 Feb 2007) Disponible en: http://www.icsi.org/guide/Dyspep.pdf
3. Aymerich M, Baena JM, Boix C, Carrillo R, Madrilejos R, Mascort JJ et al. Direcció clínica en l’atenció primària. Dispepsia - H. pylori. Guies de pràctica clínica i material docent. (Monografía en Internet) 2005 (citado 20 Feb 2007). Disponible en: http://www.gencat.net/ics/professionals/guies/dispepsia/dispepsia.htm
4. Agreus L. Natural history of dyspepsia. Gut. 2002; 50 (Supl. 4): 2-9.
5. Grupo de trabajo de la guía de práctica clínica sobre ERGE. Manejo del paciente con enfermedad por reflujo gastroesofágico (ERGE). Guía de práctica clínica. (en Internet) Barcelona: Asociación Española de Gastroenterología, Sociedad Española de Medicina de Familia y Comunitaria y Centro Cochrane Iberoamericano; 2001. Programa de Elaboración de Guías de Práctica Clínica en Enfermedades Digestivas, desde la Atención Primaria a la Especializada: 1. (citado 20 Feb 2007).Disponible en: http://www.guiasgastro.net
6. Veldhuyzen van Zanten SJO, Flook N, Chiba N, Armstrong D, Barkun A, Bradette Metal, for the Canadian Dyspepsia Working Group. An evidence-based approach to the management of uninvestigated dyspepsia in the era of Helicobacter pylori. CMAJ. 2000; 162 (Supl. 12): 3-23.
7. Kellow JE. Organic causes of dyspepsia, and discriminating functional from organic dyspepsia. Best Pract Res Clin Gastroenterol 2001; 15: 477-487.
8. Heading RC. Prevalence of upper gastrointestinal symptoms in the general population: a systematic review. Scand J Gastroenterol. 1999; 231(Suppl): 3-8.
9. SBU - The Swedish Council on Technology Assessment in Health Care. Stomach pain -evidence-based methods in the diagnosis and treatment of dyspepsia. Stockholm; 2000.
10. Stanghellini V. Three-month prevalence rates of gastrointestinal symptoms and the influence of demographic factors: results from the Domestic International Gastroenterology Surveillance Study (DIGEST). Scand J Gastroenterol. 1999; 231(Suppl): 20-28.
11. Caballero Plasencia AM, Sofos Kontoyannis S, Martín Ruiz JL, Valenzuela Barranco M. La prevalencia de la dispepsia en España. Med Clin. (Barc) 1994; 103: 717.
12. Schwartz MD. Dyspepsia, peptic ulcer disease, and esophageal reflux disease. West J Med. 2002; 176: 98-103.
13. Turabian JL, Gutiérrez V. Variaciones en la frecuencia de las enfermedades crónicas y los factores de riesgo en atención primaria: 1985-1995. Atenc Primaria. 1996; 18: 65-69.
14. Talley NJ. Dyspepsia: management guidelines for the millennium. Gut. 2002; 50 (Supl.4): 72-78.
15. Bazaldua OV, Schneider FD. Evaluation and management of dyspepsia. Am Fam Physician. 1999; 60: 1.773-1.788.
16. Haycox A, Einarson T, Eggleston A. The health economic impact of upper gastrointestinal symptoms in the general population: results from the Domestic/International Gastroenterology Surveillance Study (DIGEST). Scand J Gastroenterol. 1999; 231(Suppl): 38-47.
17. Talley NJ, Silverstein MD, Agreus L, Nyren O, Sonnenberg A, Holtmann G. AGA technical review: evaluation of dyspepsia. Gastroenterology. 1998; 114: 582-595.
18. Fisher RS, Parkman HP. Management of non ulcer dyspepsia. N Engl J Med. 1998; 339: 1.376-1.381.
19. Barenys M, Abad A, Pons JM, Moreno V, Rota R, Granados A et al. Scoring system has better discriminative value than Helicobacter pylori testing in patients with dyspepsia in a setting with high prevalence of infection. Eur J Gastroenterol Hepatol. 2000; 12: 1.275-1.282.
20. Ferlay J, Bray F, Pisani P, Parkin DM. GLOBOCAN 2000: cancer incidence, mortality and prevalence worldwide, Version 1.0.IARC Cancer Base n.º 5. (Homepage en Internet) Lyon, IARC Press, 2001. (actualizado 03 Feb 2001; citado 20 Feb 2007). Disponible en: http://www-dep.iarc.fr/globocan/globocan.htm.
21. Moayyedi P, Mason J. Clinical and economic consequences of dyspepsia in the community. Gut. 2002; 50 (Supl. 4): 10-12.
22. Ruiz M, Vilasante F, León F, González-Lara V, González C, Crespo M et al. Cuestionario sobre calidad de vida asociada a dispepsia. Adaptación española y validación del cuestionario Dyspepsia Related Health Scale. Med Clin (Barc). 2001; 117: 567-573.
23. Enck P, Dubois D, Marquis P. Quality of life in patients with upper gastrointestinal symptoms: results from the Domestic/International Gastroenterology Surveillance Study (DIGEST). Scand J Gastroenterol. 1999; 231(Suppl): 48-54.
24. Olden KW. Are psychosocial factors of aetiological importance in functional dyspepsia? Baillieres Clin Gastroenterol. 1998; 12: 557-571.
25. Olden KW, Drossman DA. Psychologic and psychiatric aspects of gastrointestinal disease. Med Clin North Am. 2000; 84: 1.313-1.327.
26. Kay L, Jorgensen T. Epidemiology of upper dyspepsia in random population. Prevalence, incidence, natural history and risk factors. Scan J Gastroenterol. 1994; 29: 1-7.
27. Yuyuan LI, Yuqiang NIE, Weihong SHA, Hua SU. The link between social psychosocial and functional dyspepsia: An epidemiological study. Chin Med J. 2002; 115: 1.082-1.084.
28. Stanghellini V. Relationship between upper gastrointestinal symptoms and lifestyle, psychosocial factors and comorbidity in the general population: results from the Domestic/International Gastroenterology Surveillance Study (DIGEST). Scand J Gastroenterol. 1999; 231(Suppl): 29-37.
29. Pantoflickova D, Blum AL, Koelz HR. Helicobacter pylori and functional dyspepsia: a real causal link? Bailleres Clin Gastroenterol. 1998; 12: 503-532.
30. Danesh J, Lawrence M, Murphy M, Roberts S, Collins R. Systematic review of the epidemiological evidence on Helicobacter pylori infection and nonulcer or uninvestigated dyspepsia. Arch Intern Med. 2000; 160: 1.192-1.198.
31. Bazzoli F, De Luca L, Pozzato P, Zagari RM, Fossi S, Ricciardiello L et al. Helicobacter pylori and functional dyspepsia: review of previous studies and commentary on new data. Gut. 2002; 50 (Supl. 4): 33-35.
32. Elta GH, Behler EM, Colturi TJ. Comparison of coffee intake and coffee-induced symptoms in patients with duodenal ulcer, nonulcer dyspepsia, and normal controls. Am J Gastroenterol. 1990; 85: 1.339-1.342.
33. Nandurkar S, Talley NJ, Xia H, Mitchell H., Hazel S, Jones M. Dyspepsia in the community is linked to smoking and aspirin use but not to Helicobacter pylori infection. Arch Intern Med. 1998; 158: 1.427-1.433.
34. Woodward M, Morrison CE, McColl Ke. The prevalence of dyspepsia and use of antisecretory medicatioin in North Gasgow: role of Helicobacter pylori vs lifestyle factors. Aliment Pharmacol. 1999; 13: 1.505-1.509.
35. Bytzer P, Howell S, Leemon M, Young LJ, Jones MP, Talley NJ. Low socioeconomic class is a risk factor for upper and lower gastrointestinal symptoms: a population based study in 15000 Australian adults. Gut. 2001; 49: 66-67.
36. Talley NJ, Weaver AL, Zinsmeister AR. Smoking, alcohol, and nonsteroidal anti-inflammatory drugs in outpatients with functional dyspepsia and among dyspepsia subgroups. Am J Gastroenterol. 1994; 89: 524-528.
37. Talley NJ, McNeilD. Piper DW. Environmental factors and chronic unexplained dyspepsia. Association with acetaminophen but not other analgesics, alcohol, coffee, tea, or smoking. Dig Dis Sci. 1988; 33: 641-648.
38. Kurata JH, Nogawa AN. Meta-analysis of risk factors for peptic ulcer. Nonsteroidal anti-inflammatory drugs, Helicobacter pylori, and smoking. J Clin Gastroenterol. 1997; 24: 2-17.
39. Huang JQ, Sridhar S, Hunt RH. Role of Helicobacter pylori infection and non-steroidal anti-inflammatory drugs in peptic-ulcer disease: a meta-analysis. Lancet. 2002; 359: 14-22.
40. Chan FK, To KF, Wu JC, Yung MY, Leung WK, Kwok T et al. Eradication of Helicobacter pylori and risk of peptic ulcers in patients starting long-term treatment with non-steroidal anti-inflammatory drugs: a randomised trial. Lancet. 2002; 359: 9-13.
41. Straus WL, Ofman JJ, MacLean C, Morton S, Berger ML, Roth EA et al. Do NSAIDs cause dyspepsia? A meta-analysis evaluating alternative dyspepsia definitions. Am J Gastroentrol. 2002; 97: 1.951-1.958.
42. Aalykke C, Lauritsen K. Epidemiology of NSAID-related gastroduodenal mucosal injury. Best Pract Res Clin Gastroenterol. 2001; 15: 705-722.
43. The National Prescribing Center. Managing dyspepsia: the role of Helicobacter pylori. MeReC Bulletin. 2001; 12 (1): 1-4.
44. Moayyedi P, Axon AT, Feltbower R, Duffett S, Crocombe W, Braunholtz D et al. Relation of adult lifestiles and socioeconomic factors to the prevalence of Helicobacter pylori infection. Int J Epidemiol. 2002; 31: 624-631.
45. Goodwin RD, Murray BS. Generalized Anxiety disorder and peptic ulcer disease among adults in the United States. Psychosomatic Medicine. 2002; 64: 862-866.
46. Andersen IB, Jorgensen T, Bonnevie O, Gronbaek M, Sorensen TI. Smoking and alcohol intake as risk factors for bleeding and perforated peptic ulcers: a population-based cohort study. Epidemiology. 2000; 11: 434-439.
47. International Agency for Research on Cancer. Infection with Helicobacter pylori. IARC Monogr Eval Carcinog Risks Hum. 1994; 61: 177-240.
48. Correa P. Gastric neoplasia. Curr Gastroenterol Rep. 2002; 4: 463-470.
49. Madsen LG, Bytzer P. The value of alarm features in identifying organic causes of dyspepsia. Can J Gastroenterol. 2000; 14: 713-720.
50. American Gastroenterological Association medical position statement: evaluation of dyspepsia. Gastroenterology. 1998; 114: 579_581.
51. Malfertheiner P, Megraud F, O'Morain C, Hungin AP, Jones R, Axon A et al. The European Helicobacter Pylori Study Group (EHPSG). Current concepts in the management of Helicobacter pylori infection -the Maastricht 2-2000. Consensus Report. Aliment Pharmacol Ther. 2002; 16: 167-180.
52. Numans ME, Van der Graaf Y, de Wit NJ, Touw-Otten F, de Melker RA. How much ulcer is ulcer-like? Diagnostic determinants of peptic ulcer in open access gastroscopy. Fam Pract. 1994; 11: 382-388.
53. Johannessen T, Petersen H, Kleveland PM, Dybdahl JH, Sandvik AK, Brenna E et al. The predictive value of history in dyspepsia. Scand J Gastroenterol. 1990; 25: 689-697.
54. Barenys M, Rota R, Moreno V, Villafafila R, García-Bayo I, Abad A et al. Validación prospectiva de un modelo clínico predictivo de dispepsia orgánica en el ámbito de la atención primaria y de las consultas de gastroenterología (Abstract). Gastroenterol Hepatol. 2003; 26 (2): 103.
55. Adang RP, Ambergen AW, Talmon JL, Hasman A, Vismans JF, Stockbrugger RW. The discriminative value of patient characteristics and dyspeptic symptoms for upper gastrointestinal endoscopic findings: a study on the clinical presentation of 1,147 patients. Digestion. 1996; 57: 118-134.
56. Buckley MJ, Scanlon C, McGurgan P, O´Morain CA. A validated dyspepsia symptom score. Ital J Gastroenterol Hepatol. 1997; 29: 495-500.
57. Mendall MA, Jazrawi RP, Marrero JM, Molineaux N, Levi J, Maxwell JD et al. Serology for Helicobacter pylori compared with symptom questionnaires in screening before direct access endoscopy. Gut. 1995; 36: 330-333.
58. Bytzer P, Hansen JM, Schaffalitzky de Muckadell OB, Malchow-Moller A. Predicting endoscopic diagnosis in the dyspeptic patient. The value of predictive score models. Scand J Gastroenterol. 1997; 32: 118-125.
59. Coelho-Filho JM, Lima JW, Furtado GB, Castelo A. Development of a strategy to optimize the indications for the upper gastrointestinal endoscopy in patients with dyspepsia at the primary care level. Rev Assoc Med Bras. 2000; 46: 30-38.
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Camacho Assef JA, Soler Porro LL. Dispepsia: necesidad de una guía de práctica clínica para su evaluación en la atención primaria de salud. Mediciego [Internet]. 14 de septiembre de 2018 [citado 18 de abril de 2024];13(1). Disponible en: https://revmediciego.sld.cu/index.php/mediciego/article/view/2815
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