Can clinical features stratify use of endoscopy for dyspeptic patients with high background prevalence of upper gastrointestinal cancer?

Hsu, Yao Chun; Yang, Tzeng Huey; Liou, Jyh–Ming; Hsu, Wei Lun; Lin, Hwai Jeng; Wu, Huei Tang; Lin, Jaw Town; Wang, Hsiu Po; Wu, Ming Shiang

doi:10.1016/j.dld.2011.10.012

Cited by 15 publications

(16 citation statements)

References 37 publications

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“…The prevalence of organic diseases in dyspeptic patients was reported in eight studies from China, four studies from Japan and one study each from Korea, Singapore and Malaysia for a total of 152 314 patients (Table S1) . All of these studies were population‐based endoscopy studies with relatively large sample sizes; nine of the 15 studies had more than 1000 participants.…”

Section: Resultsmentioning

confidence: 99%

“…As the prevalence of malignancy and the proportion of young cancer patients can influence the evaluation of prompt endoscopy as an initial strategy for dyspepsia, we estimated the malignancy detection rate and the proportion of young cancer patients aged <45 years, 40 years and 35 years among dyspepsia patients. All 15 included studies reported the prevalence of malignancy in dyspeptic patients . The pooled rate of malignancy was estimated at 1.30% (95% CI: 0.80–2.10).…”

Section: Resultsmentioning

confidence: 99%

“…Asia in this manuscript mostly referred to eastern, southern and southeastern Asia which compassed the following areas: China, Japan, Singapore, South Korea, Malaysia, India and China Taiwan. Until recently, more Asian studies have tended to identify the cost‐effectiveness of prompt endoscopy as an initial strategy for patients with uninvestigated dyspepsia, even in the absence of alarm features, because in Asia where the prevalence of H. pylori infection and upper gastrointestinal (GI) malignancy is relatively high, a substantial proportion of gastric cancer cases would be missed if endoscopy were omitted in patients younger than 45 years of age or those lacking alarm features . Despite these efforts, uncertainty remained concerning the prevalence of malignancy among Asian dyspepsia patients, and the diagnostic value of alarm features for predicting malignancy in Asian populations.…”

Section: Introductionmentioning

confidence: 99%

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Systematic review with meta‐analysis: prompt endoscopy as the initial management strategy for uninvestigated dyspepsia in Asia

Chen

Gwee

Lee

et al. 2014

Aliment Pharmacol Ther

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Summary Background Prompt endoscopy should be considered as an initial strategy for uninvestigated dyspepsia in the background of high prevalence of Helicobacter pylori infection and malignancy. However, with changes of disease patterns and dyspepsia definition, the prevalence of organic lesions at endoscopy in dyspepsia patients and the predictive values of alarm features and age for in malignancy remain unclear in Asian population. Aims To evaluate the appropriateness of prompt endoscopy as an initial dyspepsia management strategy, we investigated the organic lesion detection rates in Asian dyspepsia patients as well as the diagnostic accuracies of alarm features and age thresholds for malignancy. Methods Literature was retrieved from MEDLINE, PubMed, Embase, Cochrane Library and CINAHL Plus. The prevalence rates of organic lesions and young cancer patients among dyspeptic patients and the sensitivities, specificities, likelihood ratios and diagnostic odds ratio (DOR) of alarm features and ages were estimated. The summary receiver operating characteristic curve was constructed and the area under the curve (AUC) calculated. Subgroup, sensitivity and meta‐regression analyses were performed. Results Of the 18 included studies, 15 reported organic lesion detection rates, and six and five analysed the predictive values of alarm features and ages respectively. The overall malignancy detection rate was 1.3% (95% CI: 0.80–2.10). Among cancer patients, 17.8% (95% CI: 10.90–29.00) were younger than 45 years and 3.0% (95% CI: 2.50–3.50) were younger than 35 years. The diagnostic accuracy of alarm features for predicting malignancy was moderate (DOR: 4.87, 95% CI: 2.72–8.71; AUC = 0.74). The diagnostic accuracy at age >35 years (DOR: 9.41, 95% CI: 7.89–11.21; AUC = 0.82) was better than that at age >45 years (DOR: 3.50, 95% CI: 2.32–5.27; AUC = 0.70). Conclusions The malignancy detection rate and proportion of young cancer patients were high among Asian dyspepsia patients. Alarm features and age were of limited value for predicting malignancy, and prompt endoscopy should be considered as the initial strategy for dyspepsia in Asian populations. The optimal age threshold for endoscopy screening in Asia might be 35 years.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Systematic review with meta‐analysis: prompt endoscopy as the initial management strategy for uninvestigated dyspepsia in Asia

Chen

Gwee

Lee

et al. 2014

Aliment Pharmacol Ther

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“…The rapid introduction of new diagnostic criteria for dyspepsia has made very difficult or virtually impossible to compare prevalence rates from different periods or geographic regions [10]. Because structural upper gastrointestinal (UGI) tract diseases, such as peptic ulcer, erosive esophagitis, luminal strictures and malignancy can course with dyspepsia, esophagogastroduodenoscopy (EGD) is the diagnostic procedure of choice to differentiate patients with organic from those with functional dyspepsia [11]. Although it is possible to propose endoscopy as the initial strategy for dyspepsia [12], the establishment of this procedure for every dyspeptic patient may not be practical approach, as the high prevalence of the syndrome will result in very high costs to any health system [13].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, the diagnostic procedure and its cost effectiveness must be considering that a large number of uninvestigated dyspepsia are functional cases [14]. Thus, the use of endoscopy in the management of uninvestigated dyspepsia remains a controversial issue worldwide [11]. The frequency of uninvestigated dyspepsia varies considerably in different populations and such differences may be related to true differences in the frequency of the condition or the criteria used to diagnose dyspepsia [15].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic findings in uninvestigated dyspepsia

et al. 2014

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BackgroundIt is important to know the causes of dyspepsia to establish the therapeutic approach. Dyspepsia is a frequent syndrome in our country, where there are restrictions to endoscopy and high prevalence of Helicobacter pylori (H. pylori) infection. This study aimed to assess the endoscopic findings of the syndrome, in an outpatient screening clinic of a tertiary hospital in São Paulo.MethodsOutpatients with uninvestigated dyspepsia, according to Rome III criteria, answered a dyspepsia questionnaire and underwent esophagogastroduodenoscopy. The Rapid Urease Test was applied to fragments of the antral mucosa and epidemiological data were collected from the studied population. Organic dyspepsia findings were analyzed with different variables to verify statistically significant associations.ResultsThree hundred and six patients were included and 282 were analyzed in the study. The mean age was 44 years and women comprised 65% of the sample. Forty-five percent of the patients reported alarm symptoms. Functional dyspepsia was found in 66% of the patients (20% with normal endoscopy results and 46% with gastritis), 18% had GERD and 13% had ulcers (duodenal in 9% and gastric in 4%). Four cases of gastric adenocarcinoma were identified (1.4%), one without alarm characteristics, 1 case of adenocarcinoma of the distal esophagus and 1 case of gastric lymphoma. The prevalence of H. pylori was 54% and infection, age and smoking status were associated with organic dyspepsia. The age of 48 years was indicative of alarm signs.ConclusionsThe endoscopic diagnosis of uninvestigated dyspepsia in our setting showed a predominance of functional disease, whereas cancer was an uncommon finding, despite the high prevalence of H. pylori. Organic dyspepsia was associated with infection, age and smoking status.

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A Simple Pre-endoscopy Score for Predicting Risk of Malignancy in Patients with Dyspepsia: A 5-Year Prospective Study

et al. 2018

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Can clinical features stratify use of endoscopy for dyspeptic patients with high background prevalence of upper gastrointestinal cancer?

Cited by 15 publications

References 37 publications

Systematic review with meta‐analysis: prompt endoscopy as the initial management strategy for uninvestigated dyspepsia in Asia

Systematic review with meta‐analysis: prompt endoscopy as the initial management strategy for uninvestigated dyspepsia in Asia

Endoscopic findings in uninvestigated dyspepsia

A Simple Pre-endoscopy Score for Predicting Risk of Malignancy in Patients with Dyspepsia: A 5-Year Prospective Study

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