P4081 - The Impact of Language in Utilization of Upper Endoscopy for Diagnosis of Functional Dyspepsia

Noor Syed, MD¹, Ahmad Kamal, MD², Linda Anh Nguyen, MD^3
1Santa Clara Valley Medical Center, Saratoga, CA; ²Santa Clara Valley Medical Center, San Jose, CA; ³Stanford University, Redwood City, CA

Introduction: Functional dyspepsia (FD) is a disorder of gut-brain interaction (DGBI) characterized by recurring abdominal pain and indigestion. Studies of healthcare utilization in patients with irritable bowel syndrome (IBS) have found that those who self-identify as “Hispanic,” “Black” or “Asian” are more likely to undergo invasive procedures than matched “White” patients with IBS. However, the impact of a patient's preferred language on risk of undergoing procedures is unknown. Since communication and education are key components of FD treatment, we investigated whether non-English speaking patients were more likely to undergo an invasive work-up.

Methods: We retrospectively reviewed charts of 160 patients with a diagnosis of FD in a large public health system serving a diverse population. We excluded patients under age 18, or with a history of peptic ulcer disease, gastric cancer, gastric surgery, or alarm symptoms. Our primary outcome was having had an upper endoscopy as part of FD work-up. Data were analyzed using Pearson’s chi square test with Yates’ continuity correction for categorical data, and Student’s unpaired t-test for continuous data. Logistic regression was used to correct for the impact of covariates. All p-values are 2-sided. Tests were implemented on R version 4.3.0.

Results: Fifty-three patients reported Spanish as their primary language; 82 reported English, and 26 reported another language (Table 1). Spanish-speaking patients underwent upper endoscopy at a higher rate in the evaluation of FD (60% vs. 36%, p = 0.004). After correcting for age, gender, obesity, diabetes and Hispanic ethnicity, being a Spanish speaker remained an independent risk factor for undergoing EGD (OR 3.9, p= 0.008). We did not see increased utilization of EGD in the “other” language group compared to English speakers.

Discussion: FD is a diagnosis which relies on patients' descriptions of symptoms that meet diagnostic criteria developed in English. These results suggest that a communication gap and perhaps cultural nuances may lead to uncertainty around the diagnosis and a resultant increased use of endoscopy. The lack of difference in EGD utilization in the “other” language group was likely due to a small sample size. Further studies should investigate if these differences are observed in a larger cohort, across multiple different languages and importantly, whether provider language concordance changes the outcomes.


Disclosures:


Noor Syed, MD¹, Ahmad Kamal, MD², Linda Anh Nguyen, MD³. P4081 - The Impact of Language in Utilization of Upper Endoscopy for Diagnosis of Functional Dyspepsia, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.