Dyspeptic symptoms and endoscopic findings in the community: the Loiano-Monghidoro study.
We aimed to evaluate the prevalence of endoscopic findings and their association with dyspeptic symptoms in the community. A total of 1,533 inhabitants of two villages were invited to participate in a cross-sectional survey, and 1,033 were recruited. Participants underwent a validated dyspepsia questionnaire, upper gastrointestinal endoscopy, and a (13)C-urea breath test. Endoscopic findings were present in 17.6% of asymptomatic subjects and in 27.4% of those with dyspeptic symptoms. The prevalence of esophagitis and Barrett's esophagus in subjects with dyspeptic symptoms and without prominent reflux symptoms was 8.1 and 1.5%, respectively, and was similar to that of asymptomatic subjects (8.5 and 0.7%, respectively). Esophagitis was significantly associated with dyspeptic symptoms only in subjects with concomitant prominent reflux symptoms. Peptic ulcer (PU) was present in 8.8% of subjects with dyspeptic symptoms without reflux symptoms and similarly in 9.4% of those with prominent reflux symptoms. Subjects with dyspeptic symptoms and concomitant prominent reflux symptoms had an increased risk of having an underlying PU (odds ratio 2.74, 95% confidence interval 1.30-5.78). Almost three-quarters of subjects with dyspeptic symptoms do not have endoscopic findings and, in addition, esophagitis may not be the cause of dyspeptic symptoms in subjects without prominent reflux symptoms. PU may be the cause of dyspeptic symptoms in a subgroup of subjects with prominent reflux symptoms.