Burden and Treatment of Chronic Upper GI Symptoms and Diagnoses – a Nationwide Study

BACKGROUND AND AIMS:Chronic gastrointestinal (GI) symptoms are a common reason for seeking medical care. We aim to determine the rates of ambulatory care use and to characterize demographics, work up, and treatment (pharmacologic and nonpharmacologic) for patients chronic upper GI symptoms and conditions in the United States. METHODS:Estimates of annual visits for the most common upper GI symptoms and diagnoses including GERD, dyspepsia, nausea and vomiting, and gastroparesis, were recorded from the 2007-2015 National Ambulatory Medical Care Surveys. Only chronic conditions, defined as > 3 months, were included. We calculated the weighted proportion of ambulatory visits associated with pharmacologic, non-pharmacologic treatment (diet, CAM, etc.), or both. RESULTS:A total of 116,184,475 weighted ambulatory visits were identified between the years of 2007-2015 for adults (average of 12,909,386 annual visits) with chronic upper GI symptoms and diagnoses. GERD was the most common reason for an ambulatory visit (n=11,200,193), followed by dyspepsia (n=1,232,598), nausea and vomiting (n=714,834), and gastroparesis (n=140,312). Pharmacologic treatment was more common than non-pharmacologic treatment (44.7% vs. 28.5%). 37.6% of patients were not receiving treatment at the time of the visit. These treatment patterns did not significantly change over the time of our study. Upper endoscopies were the most ordered test, representing 7.5% of all investigated upper GI symptoms. CONCLUSIONS:Chronic upper GI symptoms and diagnoses account for a high number of annual health care visits, both in primary care and specialty care. While there are several treatments, many these patients are not on any treatments.