Letters Section Editor: Robert M. Golub, MD, Senior Editor.
In Reply: Dr Badgett raises questions about the ability of the studies we reviewed to identify patients at very low risk of organic disease. The studies we selected in our systematic review dichotomized patients with dyspepsia into organic vs functional and did not report the data in terms of low, intermediate, and high risk of organic disease. Badgett points out that this has been performed for pulmonary embolism and myocardial infarction. However, those studies evaluated the combination of clinical findings and results of diagnostic tests rather than just relying on clinical impression alone. The approaches are therefore not completely analogous. Furthermore, many of the dyspepsia articles were evaluating whether the clinician could distinguish among esophagitis, peptic ulcer, gastrointestinal cancer, and functional gastrointestinal disease. A 3-point scale for all of these disorders would be difficult to interpret.
Moayyedi P, Talley NJ, Fennerty MB, Vakil N. Distinguishing Organic and Functional Dyspepsia by History. JAMA. 2006;296(11):1352-1353. doi:10.1001/jama.296.11.1352-b