Current guidelines recommend endoscopy for dyspeptic patients over 45 years of age and/or with "alarm" symptoms.
The management of younger patients with uncomplicated dyspepsia is controversial.
Dr Cipolletta and colleagues from Italy aimed to identify any risk factors predictive of upper gastrointestinal malignancy in patients with uncomplicated dyspepsia and validate their ability in refining indications for endoscopy.
The investigative team analyzed a prospective database of consecutive uninvestigated dyspeptic outpatients undergoing endoscopy.
A questionnaire including multiple possible prognostic variables was systematically submitted to patients prior to endoscopic examination.
| The mean age of females with cancer was almost 10 years higher compared to males|
|American Journal of Gastroenterology|
The team identified risk factors for upper gastrointestinal malignancy and used these to derive a prediction rule subsequently validated on an independent population.
The researchers considered a total of 5224 patients with uncomplicated dyspepsia of which 22 had malignancy at endoscopy.
These patients were about 20 years older than patients with no malignancy and the majority of patients were male (n=16).
The research team noted that the mean age of females with cancer was almost 10 years higher compared to males.
The investigators confirmed this difference in age in a split sample of 3684 patients with age cut-offs of 35 years for males and 56 years for females.
Dr Cipolletta’s team concluded, “The age threshold for endoscopy should be lowered in males to decrease the risk of missing cancers, and can be safely increased in females without affecting outcomes.”
“In patients with uncomplicated dyspepsia, the combination of age and gender provides a better discriminant power than age alone.”