Use of upper GI tract endoscopy for patients with dyspepsia could potentially be reduced more than 40% by implementing relevant web-based patient education, a study suggests.

The findings, published in JAMA Internal Medicine, suggest that education to improve patients’ knowledge and dispel misconceptions about upper GI tract disease might be reassuring enough to translate into fewer low-value procedures.

The Dutch study randomised 119 patients with dyspepsia to either a web-based educational intervention covering causes, consequences, and self-management of dyspepsia or usual care of an upper GI endoscopy.

The open-label RCT found significantly fewer patients in the education group than the controls underwent upper GI endoscopy in the 12 weeks following randomisation (39% v 82%; p<0.001).

The study said the number needed to educate to prevent one upper GI tract endoscopy was five.

In secondary outcomes, there was equal improvement of symptom severity and quality of life seen in both groups during 12 months follow-up. Health-related anxiety improved only for patients who received the education.

Additionally, the study found no clinically relevant findings in 82% of the upper GI endoscopies.

The few clinically relevant findings were H. pylori-associated gastritis, reflux oesophagitis grade B, C or D, Barrett oesophagus and gastric ulcer. In procedures resulting in biopsy, there were no cases of coeliac disease or malignancy.

Endoscopic findings did not differ between patients with or without PPI use.

The study said upper GI endoscopy was frequently performed to reassure patients.

“We found that educating patients with dyspepsia was equally effective to performing upper GI tract endoscopy in controlling symptom severity and improving the quality of life,” the researchers said.

The study said international guidelines such as those from the National Institute for Health and Care Excellence (NICE) recommend a conservative approach to the use of upper GI tract endoscopy for dyspepsia.

“We advocate the implementation of an online accessible patient education platform for dyspepsia management, in both primary and secondary care, to further decrease overuse of health care,” they concluded.