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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 . . . [Full Text of this Article]

Robert Badgett, MD
badgett@uthscsa.edu
University of Texas Health Science Center
San Antonio

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