[Skip to Navigation]
Original Investigation
Less Is More
April 26, 2021

Web-Based Educational Intervention for Patients With Uninvestigated Dyspepsia Referred for Upper Gastrointestinal Tract Endoscopy: A Randomized Clinical Trial

Author Affiliations
  • 1Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands
  • 2Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands
  • 3Department of Gastroenterology and Hepatology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
  • 4Department of Gastroenterology and Hepatology, Viecuri Medical Centre, Venlo, the Netherlands
  • 5Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, the Netherlands
  • 6Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
  • 7Department of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, the Netherlands
  • 8Scientific Centre for Quality of Healthcare, IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
JAMA Intern Med. 2021;181(6):825-833. doi:10.1001/jamainternmed.2021.1408
Visual Abstract. Effect of web-based educational intervention for patients with uninvestigated dyspepsia referred for upper gastrointestinal tract endoscopy
Effect of web-based educational intervention for patients with uninvestigated dyspepsia referred for upper gastrointestinal tract endoscopy
Key Points

Question  Can dedicated health education for patients with uninvestigated dyspepsia reduce the number of upper gastrointestinal tract endoscopic procedures?

Findings  This open-label, multicenter, clinical trial randomized 119 patients between health education or usual care and found that educating patients on dyspepsia greatly and sustainably decreased the number of upper gastrointestinal tract endoscopic procedures (39% vs 82%).

Meaning  Educating patients with uninvestigated dyspepsia effectively decreases the need for upper gastrointestinal tract endoscopic procedures.


Importance  Diagnostic yield of upper gastrointestinal (GI) tract endoscopy for uninvestigated dyspepsia is low, and its clinical implications are limited. There is an unmet need for better strategies to reduce the volume of upper GI tract endoscopic procedures for dyspepsia.

Objective  To study the effectiveness of a web-based educational intervention as a tool to reduce upper GI tract endoscopy in uninvestigated dyspepsia.

Design, Setting, and Participants  This open-label, multicenter, randomized clinical trial enrolled participants between November 1, 2017, and March 31, 2019, with follow-up 52 weeks after randomization, at 4 teaching hospitals in the Netherlands. Participants included patients with uninvestigated dyspeptic symptoms who were referred for upper GI tract endoscopy by their general health care clinician without prior consultation of a gastroenterologist. A total of 119 patients, aged 18 to 69 years, were included. Patients were excluded if any of the following red flag symptoms were present: (indirect) signs of upper GI tract hemorrhage (hematemesis, melena, hematochezia, or anemia), unintentional weight loss of 5% or higher of normal body weight during a period of 6 to 12 months, persistent vomiting, dysphagia, or jaundice.

Interventions  Patients were randomly assigned (1:1) to education (intervention) or upper GI tract endoscopy (control). Education consisted of a self-managed web-based educational intervention, containing information on gastric function, dyspepsia, and upper GI tract endoscopy.

Main Outcomes and Measures  Difference in the proportion of upper GI tract endoscopy procedures between those who received access to the web-based educational intervention and those who did not at 12 weeks and 52 weeks after randomization, analyzed in the intention-to-treat population. Secondary outcomes included quality of life (Nepean Dyspepsia Index) and symptom severity (Patient Assessment of Gastrointestinal Disorders Symptom Severity Index) measured at baseline and 12 weeks.

Results  Of 119 patients included (median age, 48 years [interquartile range, 37-56 years]; 48 men [40%]), 62 were randomized to web-based education (intervention) and 57 to upper GI tract endoscopy (control). Significantly fewer patients compared with controls underwent upper GI tract endoscopy after using the web-based educational intervention: 24 (39%) vs 47 (82%) (relative risk, 0.46; 95% CI, 0.33-0.64; P < .001). Symptom severity and quality of life improved equivalently in both groups. One additional patient in the intervention group required upper GI tract endoscopy during follow-up.

Conclusions and Relevance  Findings of this study indicate that web-based patient education is an effective tool to decrease the need for upper GI tract endoscopy in uninvestigated dyspepsia.

Trial Registration  ClinicalTrials.gov Identifier: NCT03205319

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words