Everyday stereotypes of general practitioners in management of patients with dyspeptic complaints: results of computer survey

Limited studies examining general practitioners’ (GPs) adherence to guidelines for managing dyspepsia indicate insufficient quality of care for this population group in various parts of the world. In Ukraine, this issue has not been studied until now. Objective — to examine the adherence of GPs to contemporary recommendations for managing patients with dyspepsia, including the 2020 Clinical Guidelines of the Ukrainian Gastroenterological Association. Materials and methods. A survey of 132 GPs was conducted using an online MS Forms questionnaire. It included 3 clinical cases with typical clinical manifestations of postprandial distress syndrome (PDS), epigastric pain syndrome (EPS), and overlap of both subtypes (PDS/EPS). Respondents were asked to determine the clinical diagnosis, list relevant tests, and prescribe preliminary pharmacological therapy with an unlimited choice of drugs. Two independent experts evaluated the responses. Results. The correct provisional diagnoses for all cases were «uninvestigated dyspepsia» or «functional dyspepsia», chosen in 46.23% of responses. Doctors slightly favored «uninvestigated dyspepsia». The dyspepsia subtype was correctly identified by 47% of respondents for PDS, 70% for EPS, and 56% for the overlap of PDS/EPS. Despite the absence of alarm symptoms and the patients being younger than 40 years, 76.2% of GPs recommended upper endoscopy. This can be attributed to the heightened awareness of stomach cancer, which has a high incidence rate in Ukraine. Other tests (general blood test, ultrasound examination) were prescribed appropriately, with 77.2% of respondents suggesting Helicobacter pylori testing. Ideal symptomatic therapy included prescribing a proton pump inhibitor (PPI) or an H2‑receptor antagonist for EPS and prokinetics for PDS. In cases of overlap, both drug types are required. This paradigm was followed by 14.1% of respondents. Additionally, 21.5% of doctors suggested an acceptable regimen involving only potent secretion inhibitors without prokinetics for PDS. The most common mistakes were polypharmacy, prescribing myotropic antispasmodics, and empirically eradicating H. pylori. Conclusions. This survey revealed insufficient adherence to current recommendations for diagnosing, testing, and treating dyspepsia among GPs in the Vinnytsia region, mirroring the situation in other countries. Real improvements could be achieved by creating simplified guidelines targeted at primary care providers, approved by the Ministry of Health of Ukraine as official departmental instructions. There is a need for improving the Continuing Medical Education system, incorporating real motivational mechanisms.