Authors' objectives:

To review the scientific evidence for using gastroscopy to diagnose dyspepsia and the current use of gastroscopy in Sweden.

Authors' results and conclusions: Symptoms of dyspepsia are responsible for about 2-4% of all ambulatory physician visits in Sweden - about 374,000 visits annually. Since 1975, the number of x-ray examinations of the stomach has decreased dramatically (from 175,000 to 52,000) and gastroscopy examinations have increased from about 20,000 to more than 100,000 with a decrease in the total number of stomach examinations for dyspepsia. Gastroscopy is performed at all of the 93 hospitals in Sweden which have a department of medicine and surgery, 6 private units and 3 community health centres. During 1987 about 106,000 examinations were performed by 907 physicians, most of whom were specialists. More than 50% of examinations were performed on referral from the primary care level. The following issues were identified: education of endoscopists, competence levels, importance of minimising waiting times, value of combining the examination with taking a mucous membrane specimen, and the importance of well defined indications for gastroscopic examination. The direct cost for a gastroscopy examination is 850 SEK, and 910 SEK for a double contrast x-ray examination of the stomach. Gastroscopy has the lowest cost per discovered morbid change.

Authors' recommendations: Gastroscopic examination of the oesophagus, stomach and duodenum provides better diagnostic information than x-ray examination for dyspepsia. Gastroscopy should replace x-ray examination of such symptoms. Restrictive use of gastroscopy is suitable amongst younger patients and older patients with serious morbid conditions, especially cardiac illness. To decrease the risk of excessive use of gastroscopy, the opportunities for stricter indications should be studied. This is an urgent area for research. The terminology and the design of reports from endoscopic examinations should be standardised through speciality associations. Gastroscopy is an important and necessary examination method and should be organisationally based where there is competence, interest and frequent examination opportunities. Education should be available for physicians and other staff who work with gastroscopy. The responsibility for this education rests with the county councils. Due to the resulting decrease in the number of x-ray examinations of the stomach, it is particularly important to ensure that the reduced number of ventricular x-ray examinations are performed with high competence and quality.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.sbu.se/Published

Year Published: 1990

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Sweden

Organisation Name: Swedish Agency for Health Technology Assessment and Assessment of Social Services

Contact Address: P.O. Box 3657, SE-103 59 Stockholm, Sweden. Tel: +46 8 4123200, Fax: +46 8 4113260

Contact Name: registrator@sbu.se

Contact Email: registrator@sbu.se

Copyright: The Swedish Council on Technology Assessment in Health Care