1. Rocco Maurizio Zagari, MD, Graham Richard Law, PhD, Lorenzo Fuccio, MD, Paolo Pozzato, MD, David Forman, Phd and Franco Bazzoli, MD.

2. INTRODUCTION  Chronic and recurrent dyspeptic symptoms Common symptoms in general population  Epigastric pain, postprandial fullness, early satiety, etc. Endoscopycally negative condition: functional dyspepsia Endoscopycally organic lesions: peptic ulcer, esophagitis Such lesion with asymptomatic conditions  Dyspeptic symptoms Less likely associated with esophagitis With prominent heartburn or regurgitation : associated with gastroesophageal reflux disease with or without esophagitis In primary care study, prevalence of peptic ulcer  With prominent reflux symptoms ≈ without symptoms

3. INTRODUCTION  Endoscopic findings and symptoms Unclear state Improve the management of patients with uninvestigated dyspepsia Sorreisa study in Norway  Asymptomatic peptic ulcers - quite common  Several potential methodological problems  Symptoms were not assessed using a validated questionnaire Kalixanda study in Sweden  Ulcer frequently show atypical symptoms  Provided only data on the association between dyspeptic symptoms and peptic ulcer

4. PURPOSES  In this study, General population in Italy The prevalence of endoscopic findings and their association with dyspeptic symptoms in the community

5. METHODS: Study population  MICOL Multicentre Italian Study on Cholelithiasis Loiano and Monghidoro near Bologna in Northern Italy Gave informed consent : UBT as part of an additional study of H. pylori infection.

6. METHODS: Assessments  Participants A validated dyspepsia questionnaire Upper gastrointestinal endoscopy 13 C-urea breath test Discontinuation of PPI, H2Rc antagonist, antibiotics at least 4wks  Gastrointestinal symptoms questionnaire Frequency and severity At least once a month for 3 months during the previous year Collected data on following symptoms

7. Definition Dyspeptic symptomsepigastric pain postprandial fullness or early satiety Reflux symptomsHeart burning Regurgitation Alarm symptomsDysphagia (Odynophagia) Alarm signsrecurrent vomiting Unexplained weight loss Sign of UGI bleeding : IDA, hematochezia, melena Frequent symptomOccurred at least 2 days/week Regardless of the severity Infrequent symptomOnce a week ~ once a month At least moderate severity METHODS: Assessments

8.  Upper gastrointestinal endoscopy Mucosal erythema of esophagus: excluded Esophagitis: Savary-Miller Classification Barrett’s esophagus diagnosed by biopsy Peptic ulcer : >3mm mucosal break Acute gastrointestinal erosions : <3mm mucosal break  H. pylori status Rapid urea test Histology 13 C-urea breath test H. pylori (+): two of these three were positive

9. Savary-Miller Classification Grade I Grade II Grade IIIGrade IV

10. METHODS: Statistical methods  Risk assessment Symptomatic subject compared with those asymptomatic Odds ratios(OR), 95% confidence intervals(CI)  Calculated after adjustment for sex, age, body mass index  H. pylori, alcohol, smoking, coffee  Medication: NSAID, aspirin, corticosteroids  Using in Stata (StataCorp 2005. Stata Statistical soft ware: Release 9. College station, TX: Stata Corp LP)

11. RESULTS: Symptoms

12. RESULTS: Endoscopic findings 38% 30% 36% 51% 21%

13. RESULTS: Endoscopic findings (OR 25.51%, 95%CI 4.62~140.98)

14. RESULTS: Endoscopic findings

15. CONCLUSION  Almost 3/4 of subjects with dyspeptic symptoms do not have endoscopic findings  Esophagitis may be the cause of dyspeptic symptoms in subjects with prominent reflux symptoms  Peptic ulcer may be the cause of dyspeptic symptoms in a subgroup of subjects with or without prominent reflux symptoms