The role of endoscopy in dyspepsia

Shaukat, Aasma; Wang, Amy; Acosta, Ruben D.; Bruining, David H.; Chandrasekhara, Vinay; Chathadi, Krishnavel V.; Eloubeidi, Mohamad A.; Fanelli, Robert D.; Faulx, Ashley L.; Fonkalsrud, Lisa; Gurudu, Suryakanth R.; Kelsey, Loralee R.; Khashab, Mouen A.; Kothari, Shivangi; Lightdale, Jenifer R.; Muthusamy, V. Raman; Pasha, Shabana F.; Saltzman, John R.; Yang, Julie; Cash, Brooks D.; DeWitt, John M.

doi:10.1016/j.gie.2015.04.003

Cited by 65 publications

(47 citation statements)

References 56 publications

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“…Patients were grouped into those referred for urgent OGD for investigation of suspected cancer (within 2 weeks as recommended by NICE6) in the presence of alarm symptoms (patients with dysphagia or aged 55 years and over with weight loss and upper abdominal pain and/or reflux and/or dyspepsia) and those only requiring a routine OGD. There was no significant difference in the frequency of endoscopic findings that required management other than empirical PPI or a ‘test-and-treat’ approach between the two groups (urgent vs routine, 15% vs 13.1%, p=0.61).…”

Section: Resultsmentioning

confidence: 99%

“…American guidelines for managing dyspepsia adopt a similar approach 6. For uninvestigated dyspepsia, NICE guidelines recommend a Helicobacter pylori ‘test and treat’ approach or an empirical 4-week trial of full-dose proton pump inhibitor (PPI) treatment and step down therapy to the lowest dose needed to control symptoms.…”

Section: Introductionmentioning

confidence: 99%

“…This would effectively treat the majority of patients with peptic ulcer or reflux disease without recourse to invasive investigation. Urgent direct referral for OGD (the ‘2 week wait’ pathway) is recommended for patients with suspected cancer: those over 55 years of age who have dyspepsia or reflux symptoms that are treatment resistant, associated with weight loss, nausea, vomiting or a raised platelet count 6. This was introduced as part of the UK Department of Health Cancer Plan to improve early cancer detection and treatment 7…”

Section: Introductionmentioning

confidence: 99%

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Reassessing the value of gastroscopy for the investigation of dyspepsia

Ching

Hale

Sidhu

et al. 2017

Frontline Gastroenterol

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reassessing the value of gastroscopy for the investigation of dyspepsia

Ching

Hale

Sidhu

et al. 2017

Frontline Gastroenterol

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“…In the United States, well‐established guidelines delineate symptoms which merit upper endoscopy. These warning symptoms, which include weight loss and iron deficiency anemia, have been correlated with malignancy in Caucasian populations . However, current literature and guidelines do not take into account the dynamic ethnic landscape of the United States and the high frequency of gastric cancer in Hispanic or Asian patients.…”

Section: Discussionmentioning

confidence: 99%

“…In the United States, current guidelines recommend endoscopic evaluation of worrisome upper gastrointestinal symptoms such as unintended weight loss, iron deficiency anemia, and dysphagia . Unfortunately, patients with potentially curable gastric cancer often do not have these alarm symptoms and their presence heralds incurable disease .…”

Section: Introductionmentioning

confidence: 99%

High‐risk symptoms do not predict gastric cancer precursors

Jani

Gupta

et al. 2018

Helicobacter

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Background & Study Aims Gastric intestinal metaplasia (GIM) is the most common precursor of gastric cancer. Our aim is to determine if presenting symptoms predict gastric cancer precursor lesions in a high‐risk population. Patient and Methods Consecutive unique patients evaluated by endoscopy for upper gastrointestinal symptoms at the Los Angeles County Hospital between 2010 and 2014 were evaluated. Presenting symptoms were classified as low‐ or high‐risk depending on the procedure indication as coded using the Clinical Outcomes Research Initiative (CORI) system. Endoscopy and histology results were used to classify findings as benign, GIM, high‐risk GIM, or malignant. The primary outcome was the proportion of patients with premalignant or malignant gastric findings who had high‐risk clinical indications for endoscopy relative to those with benign results. Results A total of 3699 patients underwent endoscopy to evaluate upper gastrointestinal symptoms. There were 373 (10.1%) patients with GIM of which 278 had high‐risk GIM. One hundred and sixty (4.3%) patients were diagnosed with gastric cancer. High‐risk indications for upper endoscopy predicted gastric cancer (OR 1.8 [95% CI 1.3‐2.6]) but not GIM (OR 1.0 [0.8‐1.3]) or high‐risk GIM (OR 0.9 [0.7‐1.2]). Hispanic or Asian patients and patients >50 years old were more likely to have GIM, high‐risk GIM, and cancer. Conclusions Performance of upper endoscopy for high‐risk indications is inadequate to detect GIM and marginal for malignancy. At risk patients should undergo upper endoscopy for both low‐ and high‐risk symptoms. Screening certain populations deserve additional study and may, in fact, be cost‐effective.

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Functional Dyspepsia

2019

Yamada's Handbook of Gastroenterology

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The role of endoscopy in dyspepsia

Cited by 65 publications

References 56 publications

Reassessing the value of gastroscopy for the investigation of dyspepsia

Reassessing the value of gastroscopy for the investigation of dyspepsia

High‐risk symptoms do not predict gastric cancer precursors

Functional Dyspepsia

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