Gastric cancer and other endoscopic diagnoses in patients with benign dyspepsia

Abstract

Background-It has been suggested that endoscopy could be replaced with noninvasive assessment of helicobacter status in the initial work up of young dyspeptic patients without sinister symptoms. Aims-To determine the incidence of gastro-oesophageal malignancy in young dyspeptic patients. Methods-The Alberta Endoscopy Project captured clinical and demographic data on all endoscopies performed from April 1993 to February 1996 at four major adult hospitals in Alberta. The endoscopic and histological diagnosis in a subgroup of patients under 45 years of age without alarm symptoms that had undergone gastroscopy was reviewed. In addition, a random list of 200 patients was generated and their medical records reviewed in order to assess the proportion with symptoms suitable for a non-invasive management strategy. Results-Gastroscopy was performed in 7004 patients under 45 years. In 3634 patients (56% female) alarm type symptoms were absent; 78.9% of patients had symptoms amenable to a non-invasive initial approach, giving a corrected sample size of 2867 patients (correction factor 0.789). Three gastric cancers, one case of moderate dysplasia, 10 biopsy proved cases of Barrett's oesophagus, and 19 oesophageal strictures/rings were detected within this sample. The corrected prevalence of gastric cancer in this select population was 1.05 per thousand patients. Discussion-Endoscopy yielded three gastric cancers in this sample of under 45 year old dyspeptic patients without sinister symptoms. While initial non-invasive screening with one-week triple therapy for helicobacter positive individuals is unlikely to have a detrimental outcome the physician is advised to consider endoscopy in patients with persisting, recurrent, or sinister symptoms. (Gut 2000;46:93-97)

Role of symptoms in diagnosis and outcome of gastric cancer

“…The studies, so far, reporting a high prevalence of alarm symptoms in gastro-intestinal malignancies are mainly retrospective and, according to these studies, up to 90% of patients with gastro-oesophageal malignancies present alarm symptoms at the time of endoscopy [14][15][16] . Large prospective cohort studies have achieved less significant results.…”

“…The Canadian (CADET) study, which examined 1021 patients referred from primary care units, without alarm symptoms, identified only 2 cancers [27] . Other studies have demonstrated that the endoscopic yield of cancer, in simple dyspepsia, is low and only very few of the identified cancers are resectable [15,28] . We do not know whether the incidence of malignancy in patients with uncomplicated dyspepsia is different from that in the non-dyspeptic population; but we do know that early gastro-intestinal cancers are asymptomatic and are usually diagnosed by chance in patients undergoing endoscopy for dyspeptic symptoms secondary to benign or functional conditions.…”

Malignant gastric outlet obstruction: a clinicopathological study in S. C. B. medical college hospital of Odisha, India

“…Similar result was also observed by Breslin et al where he found pyloric elongation in8% of cases. 12 Cases were first subjected to exploratory laparotomy. In 67% of cases the growth was limited to the pylorus and prepyloric region.…”

A rational approach to uninvestigated dyspepsia in primary care: review of the literature

“…227 In the Western world, however, this contention does not seem to hold as gastrointestinal malignancy is extremely rare in dyspeptic patients below 45-50 years if alarm symptoms are not present. [228][229][230] If one chooses to test for H pylori one should first have knowledge of the reliability of the test results (its positive and negative predictive value). This is not only dependent on the characteristics of the test (sensitivity and specificity) but also on the prevalence of the infection in the population.…”

“…In the absence of alarm symptoms malignancies are extremely rare under the age of 50. [228][229][230] Most patients can, therefore, safely be treated blindly with acid suppression. Endoscopy will not change the management in most of these patients.…”