To the Editor: In their Rational Clinical Examination article, Dr Moayyedi and colleagues1 discussed the use of the clinical history to distinguish organic from functional dyspepsia. They concluded that diagnosis based on symptoms is of limited use in distinguishing between organic and functional dyspepsia. I am concerned that this conclusion may be misleading if applied to all patients with dyspepsia. It is likely that some outpatients have clinical findings that suggest a very low risk of organic disease. It would therefore be informative if the authors found any studies whose analyses were designed to identify such patients.
It appears that all of the studies simply dichotomized patients into normal and abnormal. Two types of analyses could help identify very low-risk patients, even if this subgroup is small. First, a study could have classified patients into very low-risk, intermediate-risk, and high-risk categories. This approach has been used to identify patients at very low risk of pulmonary embolism.2 Second, a study that dichotomized patients could have weighted their analyses to emphasize sensitivity rather than overall diagnostic accuracy. This approach has been performed using recursive partitioning analysis to identify patients at very low risk of myocardial infarction.3
If no studies exist with an analysis that is designed to identify very low-risk patients, then we should temper our interpretation of this body of literature and urge the researchers in this field to improve their methods.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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