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The Epidemiology, Diagnosis, and Cost of Dyspepsia and H elicobater pylori Gastritis: A Case–Control Analysis in the S outhwestern U nited S tates
Author(s) -
Mapel Douglas,
Roberts Melissa,
Overhiser Andrew,
Mason Andrew
Publication year - 2013
Publication title -
helicobacter
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 79
eISSN - 1523-5378
pISSN - 1083-4389
DOI - 10.1111/j.1523-5378.2012.00988.x
Subject(s) - esophagogastroduodenoscopy , medicine , epidemiology , incidence (geometry) , helicobacter pylori , gastritis , gastroenterology , endoscopy , physics , optics
Background Dyspepsia is among the most common complaints evaluated by gastroenterologists, but there are few studies examining its current epidemiology, evaluation, and costs. We examined these issues in a large managed care system in the S outhwestern U nited S tates. Methods We conducted a retrospective case–control analysis of adults with incident dyspepsia or a H elicobacter pylori ‐related condition in years 2006 through 2010 using utilization data. Medical record abstraction of 400 cases was conducted to obtain additional clinical information. Results A total of 6989 cases met all inclusion and exclusion criteria. Women had a substantially higher risk of dyspepsia than men (14 per 1000 per year vs 10 per 1000; p < .001), and the incidence of dyspepsia increased with age such that persons in their seventh decade had almost twice the risk of those aged 18–29. Hispanic persons had a significantly higher risk of dyspepsia and positive H. pylori testing. Dyspepsia cases had a higher prevalence of other chronic comorbidities than their matched controls. Dyspepsia patients had healthcare costs 54% higher than controls even before the diagnosis was made, and costs in the initial diagnostic period were $483 greater per person, but subsequent costs were not greatly affected. Among those aged 55 and younger, the “test and treat” approach was used in 53% and another 18% had an initial esophagogastroduodenoscopy, as compared to 47 and 27%, respectively, among those over the age of 55. Conclusions Women and older adults have a higher incidence of dyspepsia than previously appreciated, and H ispanics in this region also have a higher risk. Current guidelines for dyspepsia evaluation are only loosely followed.