Systematic Review With Meta-analysis: Prompt Endoscopy As the Initial Management Strategy for Uninvestigated Dyspepsia in Asi(Aliment Pharmacol Ther 2015;41:239-252)

Abstract

SummaryDyspepsia is a common gastrointestinal (GI) symptom with 10-20% of the population in the Asia-Pacific region. Asian patients with uninvestigated dyspepsia, the diagnostic value of alarm features and the appropriateness of prompt endoscopy are remained uncertainly. Chen et al 5 performed a systematic review to evaluate the detection rate of organic diseases including upper GI malignancies and then to propose the proper initial diagnostic strategy in Asian dyspepsia patients. Among 2410 possible references, finally 18 papers (n = 152 314) were included in the analysis of detection of organic disease by endoscopy among dyspeptic patients. This study revealed that overall malignancy detection rate was 1.3% (95% confidence interval 0.8-2.1%) and among cancer patients, 17.8% were younger than 45 years, 5.0% at age＜ 40 years and 3.0% at age ＜ 35 years. The calculated detection rate of all organic diseases was 26.4% and that of peptic ulcer disease was 11.9% and esophageal disease was 5.5%. However, alarm features were shown to yield moderate diagnostic accuracy with an area under curve of 0.74. It meant limited accuracy for predicting malignancy. Therefore, authors concluded that an age of 35 years yielded relatively better diagnostic accuracy for malignancy.

Clinically significant endoscopic findings in patients of dyspepsia with no warning symptoms: A cross-sectional study

“…Finally, a few studies have shown that age might play an important role in the diagnosis of CSFs[ 24 , 25 ]. A previous study concluded that the presence of any warning feature and age ≥ 55 were associated with a higher risk of CSFs[ 26 ].…”

Significance of Endoscopyic Findings in Patients with Dyspepsia in Diyala Province - Iraq Hospital Based Study

“…Dyspepsia is a common gastrointestinal problem with over 80% of the population is affected by dyspepsia at some time in their life [1].The prevalence of dyspepsia is 10-20% in the Asia -Pacific region [2] while in the Western population range from 19 up to 41 % [3,4,5]. Dyspepsia poses a diagnostic and therapeutic challenge to the clinician [6] ,because dyspepsia is not a diagnosis, but merely a cluster of relapsing and remitting symptoms [3,7] with numerous underlying causes [8] believed to be referable to the upper gasrointestinal tract [3], thus the problem and its management remains a considerable socio-economic burden [2,3,7,9,10],although only 20 -25% of persons with dyspepsia seek medical care ,the problem is responsible for 2-5 % of visit to primary care physicians [5,[11][12][13][14].…”

“…Dyspepsia is a common gastrointestinal problem with over 80% of the population is affected by dyspepsia at some time in their life [1].The prevalence of dyspepsia is 10-20% in the Asia -Pacific region [2] while in the Western population range from 19 up to 41 % [3,4,5]. Dyspepsia poses a diagnostic and therapeutic challenge to the clinician [6] ,because dyspepsia is not a diagnosis, but merely a cluster of relapsing and remitting symptoms [3,7] with numerous underlying causes [8] believed to be referable to the upper gasrointestinal tract [3], thus the problem and its management remains a considerable socio-economic burden [2,3,7,9,10],although only 20 -25% of persons with dyspepsia seek medical care ,the problem is responsible for 2-5 % of visit to primary care physicians [5,[11][12][13][14]. Because of the non-specific nature of the symptoms [9],the definitions of dyspepsia have evolved considerably over the last decades [15] and dyspepsia subclassifications ,based on dominant symptoms , are of limited value in predicting the presence and nature of clinically significant upper gastrointestinal findings in adult dyspeptic patients [12] and the current standard for the diagnosis is Rome III criteria [9,16],symptoms must be chronic, occuring for three months within the initial 6 months of symptoms onset [9]and the patient must have one or more of the following 3 symptoms: sensation of pain or burning in the epigastrium, early satiety (inability to finish a normal sized meal),fullness during or after a meal [16].…”