Gastroscopy in younger patients: an analysis of referrals and pathologies

Abstract

Background and aim Diagnostic guidelines for the investigation of dyspepsia for patients <50 years have been implemented. However, it is unsure whether these guidelines are used appropriately. We aimed to investigate the adherence to the national guidelines of uninvestigated dyspepsia and to examine the prevalence of upper gastrointestinal pathology in patients 18–50 years. We also aimed to detect any possible risk factors for pathology in esophagogastroduodenoscopy referrals and to evaluate differences between referrals from the hospital and primary health care. Method This is a retrospective review of medical records including patients who underwent esophagogastroduodenoscopy between January 2019 and April 2020 (n = 1809). Odds ratios (OR), positive predictive values (PPV), negative predictive values (NPV), chi-square and Mann–Whitney U-tests were applied. Results In total 1708 patients were included, of whom 43.6% (n = 744) had a pathologic finding. Age group 41–50 years showed the highest prevalence with an OR 1.34 [95% confidence interval (CI), 1.07–1.69]. Helicobacter pylori testing was performed in 21.1% (n = 167) of patients with dyspepsia lacking alarm symptoms (n = 791). PPV and OR were generally low for a pathologic esophagogastroduodenoscopy. The absence of alarm symptoms showed a high NPV for significant pathology (98.7–99.6%). Significant pathology was almost exclusively found in hospital-based referrals. Conclusions Esophagogastroduodenoscopy is widely performed in young adults, often without significant findings. Adherence to the national guidelines was poor. No referral factors were associated with a significant risk for a pathologic finding. Esophagogastroduodenoscopy based on primary healthcare referrals demonstrated almost exclusively benign pathology. Significant pathology was only found via hospital-based referrals.

Gastroscopy Yield in the Young: Comprehensive Assessment of Endoscopic and Histologic Findings—A Comparative Study

“…Te incorporation of noninvasive HP testing, such as breath tests, could potentially mitigate the need for gastroscopy in a substantial number of cases, thereby reducing procedural burden and associated healthcare costs. Taken together with fndings presented by Räsänen and van Nieuwenhoven [12] indicating upper endoscopy performance based on primary healthcare referrals demonstrated almost exclusively benign pathology, this underscores the imperative need to foster enhanced cooperation between primary care providers and gastroenterologists while concurrently emphasizing the necessity to heighten awareness among primary care providers regarding the management and workup of dyspeptic patients. Noteworthy, although medical literature has mainly focused, addressed, and discussed dyspepsia as a major indication for gastroscopy in this young population [16], we provided detailed referral indications for this age group, highlighting the diverse clinical presentations and the referral trends.…”

“…Noteworthy, although medical literature has mainly focused, addressed, and discussed dyspepsia as a major indication for gastroscopy in this young population [16], we provided detailed referral indications for this age group, highlighting the diverse clinical presentations and the referral trends. Te abovementioned conclusions are also relevant to other common referral indications in young patients, where proper management and workup of patients, such as optimizing proton pump inhibitor (PPI) use and addressing lifestyle changes for those with refux-related symptoms, meticulously reviewing other causes of anemia, particularly in young female patients, and conducting a more comprehensive assessment of weight loss in the preendoscopy evaluation, have the potential to lower the need for upper endoscopic evaluation [12].…”

“…Despite these recommendations, several observations have documented poor adherence to these guidelines, with gastroscopy still being widely performed in young adults, often without signifcant fndings [11,12]. Importantly, data regarding the use and outcome of gastroscopy for young individuals under 50 years presenting with upper GI symptoms other than dyspepsia are scarce and were not evaluated in a large-scale study [13].…”

Diagnostic yield of upper gastrointestinal endoscopy in patients attending a UK centre with symptoms compatible with Rome IV functional dyspepsia

“…Limitations are that it was single centre, with a questionnaire response rate of 33%, although the findings of low diagnostic yield in those without alarm features is supported by other recent studies from the West. [13][14][15][16] Our study was performed in secondary care, with a mixed referral pattern, and the findings may not be applicable outside these clinical settings (e.g. in the community) where arguably the yield will be even lower.…”

“…The results are consistent with recent studies from the West (Canada, United States, Netherlands, and Sweden) which, having used a broader definition of dyspepsia, noted that almost a third to a half of upper GI endoscopies performed within GI clinics are in low risk dyspeptic patients without alarm features, in whom significant endoscopic findings were low, with malignancy rare. [13][14][15][16] To our knowledge, our study is the first evaluating this issue within the UK whilst using the Rome IV criteria.…”