Use of alarm features in predicting significant endoscopic findings in Nigerian patients with dyspepsia

Abstract

IntroductionDyspepsia is prevalent in the community. Guidelines recommend early endoscopy in dyspeptic patients who are older than 55 years, or have alarm features. There is a lack of data on endoscopy in patients with alarm features in Nigeria.MethodsA retrospective study of the endoscopic findings in adults with dyspepsia and alarm features, between August 1st 2017 and July 31st 2018 in Lagos, Nigeria. Data were analysed using Statistical Package for Social Sciences, version 23.0. The sensitivity, specificity, positive predictive value, and negative predictive value of the alarm features were calculated.ResultsOne hundred and fifty-nine gastroscopies were performed during this period, mean age was 47.8 (±14.4) years, 49.1% were male. Dyspepsia was the commonest indication for endoscopy (80.5%), 60.2% of the dyspeptics had at least one alarm feature. The most frequent dyspeptic symptom was epigastric pain/burning sensation (75%), while the commonest alarm features were recent onset dyspepsia in a patient over 45 years (79%) and unexplained weight loss (28.6%). Endoscopy was normal in 26%. The most frequent significant endoscopic findings were gastritis (49%) and gastric ulcer (17%) and they were not associated with alarm features. Upper gastrointestinal bleeding, persistent vomiting and odynophagia were specific for significant endoscopic findings. The pooled sensitivity, specificity, positive predictive value, and negative predictive value of the alarm features were 65%, 49%, 71% and 41% respectively.ConclusionPatients with dyspepsia and upper gastrointestinal bleeding, persistent vomiting or odynophagia, should be referred for prompt upper GI endoscopy.

Dyspepsia: when to endoscope?

“…Upper gastrointestinal bleeding, persistent vomiting and odynophagia were specific for significant endoscopic findings. 41 Both the researched studies and the one carried out here, showed that weight loss is the most prevalent alarm signal among patients who undergo upper digestive endoscopies.…”

Spectrum and pattern of distribution of findings in patients with dyspepsia undergoing oesophago-gastro-duodenoscopy at a Tertiary Hospital in Ibadan, south west, Nigeria

“…The frequency of gastric masses suspected to be malignant and indeed significant endoscopic lesions was low even in the elderly in this study, despite the frequency of H. pylori infection in the population. Many other studies in Nigeria and overseas have reported similar findings [22,24,25,34]. We know, however, that the outcome of H. pylori infection is an interaction of the virulence of the organism which is determined by its strains, host susceptibility and environmental factors [38].…”

“…A study in Atlanta, Georgia also found gastric ulcers more than duodenal ulcers among their patients with dyspepsia [29]. Similarly, Jemilohun et al [24] in Ibadan, Odeghe et al [34], in Lagos, Ugiagbe et al [25], in Benin, all in Nigeria and Agyei-Nkansah et al [11], in Ghana found gastric ulcers to be more common in patients with dyspepsia though these studies did not look at the pattern of the gastritis in their cohorts. However, other studies in Nigeria and Brazil reported duodenal ulcers to be more common than gastric ulcers [22,26,35].…”

The problem of verification of malignant neoplasms of the stomach in surgical practice

“…Таким образом, очень важен точный отбор пациентов с более высоким риском развития онкологического заболевания, которые должны быть немедленно отправлены на дополнительное обследование. При наличии «тревожных» симптомов специалисты рекомендуют проводить немедленную эндоскопию всем пациентам, поскольку данные симптомы чаще всего ассоциируются с развитием злокачественных новообразований верхних отделов желудочно-кишечного тракта [33].…”