Management of dyspeptic patients by general practitioners and specialists.

Introduction The respective roles of general practitioners and specialists in the management of most diseases is not clearly defined and dyspepsia is no exception. Ideally, the division of tasks should be based on the characteristics of diVerent diseases and on specific objectives. The prevalence of dyspepsia ranges between 20 and 40% in industrialised countries and roughly 25% of patients seek medical help, whereas the remainder often self-medicate. Although frequently idiopathic (or functional), dyspepsia can be secondary to a variety of serious (and sometimes fatal) organic, systemic and metabolic diseases that need to be identified. Functional dyspepsia also precipitates a substantial reduction in the quality of life of aVected patients with relevant costs for society. The current economic restrictions prevent referral of every patient and correct management of dyspepsia is a formidable task. Prospective studies have been undertaken to establish the respective eVectiveness of diVerent doctors in the management of some gastroenterological diseases. Zarling et al compared the eYcacy of management of acute diverticulitis provided by general practitioners, internists and gastroenterologists, and observed shorter hospital stay and lower readmission rates in patients treated by gastroenterlogists. Unlike acute diverticulitis, dyspepsia is a very heterogeneous condition and no similar studies are available as yet. Tackling the following questions may help to elucidate the remit of diVerent doctors. + What drives a dyspeptic individual to consult a physician? + Do diVerent doctors see diVerent types of dyspeptic patients? + What is the diagnostic yield of an extensive work-up by a specialist? + Should diVerent doctors adopt diVerent strategies for the management of dyspepsia? + What is the most cost-eVective way to manage dyspepsia?