The value of screening for psychiatric disorders prior to upper endoscopy

Patrick G. O'Malley, Peter W K Wong, Kurt Kroenke, Michael J. Roy, Roy K H Wong

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Gastrointestinal (GI) complaints are among the most common symptoms in primary care yet are frequently unexplained and often lead to costly diagnostic testing. We sought to determine the prevalence of psychiatric disorders in patients with unexplained GI complaints undergoing upper endoscopy, and the likelihood of endoscopic abnormalities in patients with and without psychiatric diagnoses. We prospectively evaluated 116 adult patients who were undergoing upper endoscopy to evaluate GI complaints. All subjects received a structured psychiatric interview prior to endoscopy using PRIME-MD, and endoscopists were blinded to the PRIME-MD results. Psychiatric disorders were detected in 70 (60%) patients. Overall, there were 113 diagnoses (some patients had multiple disorders) with the most common being somatoform (44%), depressive (29%), and anxiety (19%) disorders. Only 29 patients had major endoscopic abnormalities, including esophageal disease (14), peptic ulcer (9), severe gastritis (4), gastric cancer (1), and esophageal cancer (1). There was a much higher prevalence of psychiatric disorders in patients without major endoscopic abnormalities (74% vs. 21%, p <0.0001). Psychiatric disease was strongly predictive of endoscopic findings (OR for major abnormality = 0.11 in women, and 0.40 in men), especially if somatoform disorder was present (OR = 0.15). We conclude that, with a simple questionnaire, psychiatric disorders can be diagnosed in a large proportion of patients with unexplained GI complaints who are referred for upper endoscopy. The presence of a psychiatric disorder, particularly if somatoform, makes it unlikely that endoscopy will reveal significant GI disease.

Original languageEnglish (US)
Pages (from-to)279-287
Number of pages9
JournalJournal of Psychosomatic Research
Volume44
Issue number2
DOIs
StatePublished - Feb 1998
Externally publishedYes

Fingerprint

Endoscopy
Psychiatry
Somatoform Disorders
Esophageal Diseases
Gastrointestinal Diseases
Gastritis
Esophageal Neoplasms
Anxiety Disorders
Peptic Ulcer
Mental Disorders
Stomach Neoplasms
Primary Health Care
Interviews

Keywords

  • Gastrointestinal endoscopy
  • Gastrointestinal symptoms
  • Psychiatric disease

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry
  • Psychology(all)

Cite this

The value of screening for psychiatric disorders prior to upper endoscopy. / O'Malley, Patrick G.; Wong, Peter W K; Kroenke, Kurt; Roy, Michael J.; Wong, Roy K H.

In: Journal of Psychosomatic Research, Vol. 44, No. 2, 02.1998, p. 279-287.

Research output: Contribution to journalArticle

O'Malley, Patrick G. ; Wong, Peter W K ; Kroenke, Kurt ; Roy, Michael J. ; Wong, Roy K H. / The value of screening for psychiatric disorders prior to upper endoscopy. In: Journal of Psychosomatic Research. 1998 ; Vol. 44, No. 2. pp. 279-287.
@article{073d4fcea4fc4080b03f2d5bce155632,
title = "The value of screening for psychiatric disorders prior to upper endoscopy",
abstract = "Gastrointestinal (GI) complaints are among the most common symptoms in primary care yet are frequently unexplained and often lead to costly diagnostic testing. We sought to determine the prevalence of psychiatric disorders in patients with unexplained GI complaints undergoing upper endoscopy, and the likelihood of endoscopic abnormalities in patients with and without psychiatric diagnoses. We prospectively evaluated 116 adult patients who were undergoing upper endoscopy to evaluate GI complaints. All subjects received a structured psychiatric interview prior to endoscopy using PRIME-MD, and endoscopists were blinded to the PRIME-MD results. Psychiatric disorders were detected in 70 (60{\%}) patients. Overall, there were 113 diagnoses (some patients had multiple disorders) with the most common being somatoform (44{\%}), depressive (29{\%}), and anxiety (19{\%}) disorders. Only 29 patients had major endoscopic abnormalities, including esophageal disease (14), peptic ulcer (9), severe gastritis (4), gastric cancer (1), and esophageal cancer (1). There was a much higher prevalence of psychiatric disorders in patients without major endoscopic abnormalities (74{\%} vs. 21{\%}, p <0.0001). Psychiatric disease was strongly predictive of endoscopic findings (OR for major abnormality = 0.11 in women, and 0.40 in men), especially if somatoform disorder was present (OR = 0.15). We conclude that, with a simple questionnaire, psychiatric disorders can be diagnosed in a large proportion of patients with unexplained GI complaints who are referred for upper endoscopy. The presence of a psychiatric disorder, particularly if somatoform, makes it unlikely that endoscopy will reveal significant GI disease.",
keywords = "Gastrointestinal endoscopy, Gastrointestinal symptoms, Psychiatric disease",
author = "O'Malley, {Patrick G.} and Wong, {Peter W K} and Kurt Kroenke and Roy, {Michael J.} and Wong, {Roy K H}",
year = "1998",
month = "2",
doi = "10.1016/S0022-3999(97)00250-X",
language = "English (US)",
volume = "44",
pages = "279--287",
journal = "Journal of Psychosomatic Research",
issn = "0022-3999",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - The value of screening for psychiatric disorders prior to upper endoscopy

AU - O'Malley, Patrick G.

AU - Wong, Peter W K

AU - Kroenke, Kurt

AU - Roy, Michael J.

AU - Wong, Roy K H

PY - 1998/2

Y1 - 1998/2

N2 - Gastrointestinal (GI) complaints are among the most common symptoms in primary care yet are frequently unexplained and often lead to costly diagnostic testing. We sought to determine the prevalence of psychiatric disorders in patients with unexplained GI complaints undergoing upper endoscopy, and the likelihood of endoscopic abnormalities in patients with and without psychiatric diagnoses. We prospectively evaluated 116 adult patients who were undergoing upper endoscopy to evaluate GI complaints. All subjects received a structured psychiatric interview prior to endoscopy using PRIME-MD, and endoscopists were blinded to the PRIME-MD results. Psychiatric disorders were detected in 70 (60%) patients. Overall, there were 113 diagnoses (some patients had multiple disorders) with the most common being somatoform (44%), depressive (29%), and anxiety (19%) disorders. Only 29 patients had major endoscopic abnormalities, including esophageal disease (14), peptic ulcer (9), severe gastritis (4), gastric cancer (1), and esophageal cancer (1). There was a much higher prevalence of psychiatric disorders in patients without major endoscopic abnormalities (74% vs. 21%, p <0.0001). Psychiatric disease was strongly predictive of endoscopic findings (OR for major abnormality = 0.11 in women, and 0.40 in men), especially if somatoform disorder was present (OR = 0.15). We conclude that, with a simple questionnaire, psychiatric disorders can be diagnosed in a large proportion of patients with unexplained GI complaints who are referred for upper endoscopy. The presence of a psychiatric disorder, particularly if somatoform, makes it unlikely that endoscopy will reveal significant GI disease.

AB - Gastrointestinal (GI) complaints are among the most common symptoms in primary care yet are frequently unexplained and often lead to costly diagnostic testing. We sought to determine the prevalence of psychiatric disorders in patients with unexplained GI complaints undergoing upper endoscopy, and the likelihood of endoscopic abnormalities in patients with and without psychiatric diagnoses. We prospectively evaluated 116 adult patients who were undergoing upper endoscopy to evaluate GI complaints. All subjects received a structured psychiatric interview prior to endoscopy using PRIME-MD, and endoscopists were blinded to the PRIME-MD results. Psychiatric disorders were detected in 70 (60%) patients. Overall, there were 113 diagnoses (some patients had multiple disorders) with the most common being somatoform (44%), depressive (29%), and anxiety (19%) disorders. Only 29 patients had major endoscopic abnormalities, including esophageal disease (14), peptic ulcer (9), severe gastritis (4), gastric cancer (1), and esophageal cancer (1). There was a much higher prevalence of psychiatric disorders in patients without major endoscopic abnormalities (74% vs. 21%, p <0.0001). Psychiatric disease was strongly predictive of endoscopic findings (OR for major abnormality = 0.11 in women, and 0.40 in men), especially if somatoform disorder was present (OR = 0.15). We conclude that, with a simple questionnaire, psychiatric disorders can be diagnosed in a large proportion of patients with unexplained GI complaints who are referred for upper endoscopy. The presence of a psychiatric disorder, particularly if somatoform, makes it unlikely that endoscopy will reveal significant GI disease.

KW - Gastrointestinal endoscopy

KW - Gastrointestinal symptoms

KW - Psychiatric disease

UR - http://www.scopus.com/inward/record.url?scp=0032008172&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032008172&partnerID=8YFLogxK

U2 - 10.1016/S0022-3999(97)00250-X

DO - 10.1016/S0022-3999(97)00250-X

M3 - Article

C2 - 9532557

AN - SCOPUS:0032008172

VL - 44

SP - 279

EP - 287

JO - Journal of Psychosomatic Research

JF - Journal of Psychosomatic Research

SN - 0022-3999

IS - 2

ER -