The prevalence of clinically significant endoscopic findings in primary care patients with uninvestigated dyspepsia: the Canadian Adult Dyspepsia Empiric Treatment – Prompt Endoscopy (CADET–PE) study A. B. R. THOMSON*, A. N. BARKUN  , D. ARMSTRONG à , N. CHIBA à , R. J. WHITE§, S. DANIELS§, S. ESCOBEDO§, B. CHAKRABORTY§, P. SINCLAIR – & S. J. O. VELDHUYZEN VAN ZANTEN** *University of Alberta, Edmonton, Alberta;  McGill University, Montreal, Que ´bec; àMcMaster University, Hamilton, Ontario; §AstraZeneca Canada Inc, Mississauga, Ontario; –INSINConsulting, Guelph, Ontario; **Dalhousie University, Halifax, Nova Scotia; Canada Accepted for publication 18 April 2003 SUMMARY Background: Uninvestigated dyspepsia is common in family practice. The prevalence of clinically significant upper gastrointestinal findings (CSFs) in adult uninves- tigated dyspepsia patients, and their predictability based on history, is unknown. Methods: Prompt endoscopy was performed within 10 days of referral, in 1040 adult patients presenting with uninvestigated dyspepsia at 49 Canadian family practitioner centres. Subsequent management strategies during a 6-month follow-up period were determined by the individual family practitioners. Results: CSFs were identified in 58% (603/1040) of patients. Erosive oesophagitis was most common (43%; N ¼ 451); peptic ulcer was uncommon (5.3%; N ¼ 55). Alarm symptoms were uncommon (2.8%; N ¼ 29). Most patients had at least three dyspepsia symptoms, more than 80% had at least six, and approximately half had eight or more. Based on the dominant symptom, 463 (45%) patients had ulcer-like, 393 (38%) had reflux-like and 184 (18%) had dysmotility-like dyspepsia. The patients’ dominant symptom was not predictive of endoscopic findings. Oesophagitis was more common in those with dominant reflux-like symptoms and was the most common finding in all subgroups. The prevalence of gastroduodenal findings was similar in all symptom subgroups. Helicobacter pylori (H. pylori) infection (30%; 301/1013) was associated with gastroduodenal findings. Conclusions: Dyspepsia subclassifications, based on dom- inant symptom, are of limited value in predicting the presence and nature of CSFs. Oesophagitis was by far the most common diagnosis (43% of patients). CSFs were common in uninvestigated dyspepsia patients and their nature suggests patients could be initially treated effectively, without endoscopy, using empirical acid suppressive therapy. INTRODUCTION Dyspepsia is a common condition that is reported by up to 40% of the general population. 1, 2 Patients with dyspepsia account for approximately 7% of all family physician visits in Canada. 3 Dyspepsia defines an upper gastrointestinal symptom complex characterized by epigastric pain or discomfort and may include heart- burn, acid regurgitation, excessive burping/belching, abdominal bloating, feeling of abnormal or slow digestion, early satiety or nausea. 4, 5 These symptoms are often clustered into subgroups: dysmotility-like, Correspondence to: Dr Alan B. R. Thomson, 519 Robert Newton Research Building, 11315–87 Avenue, Edmonton, Alberta, Canada T6G 2C2. E-mail: alan.thomson@ualberta.ca Aliment Pharmacol Ther 2003; 17: 1481–1491. doi: 10.1046/j.0269-2813.2003.01646.x Ó 2003 Blackwell Publishing Ltd 1481