Alarm features such as dysphagia, weight loss, or anemia raise concern of an upper gastrointestinal (GI) malignancy in patients with dyspepsia.
Dr Nimish Vakil and colleagues from Wisconsin determined the diagnostic accuracy of alarm features in predicting malignancy.
The research team performed a metaanalysis based on the published literature.
English-language studies were identified by searching MEDLINE, EMBASE, Cochrane Controlled Trials Register, and CINAHL.
The team included cohort studies that measured alarm features and compared them with the endoscopic findings.
|Sensitivity of alarm symptoms varied from 0% to 83%|
Studies were screened for inclusion by 2 authors who independently extracted the data.
The researchers calculated sensitivity, specificity, and likelihood ratios by comparing the alarm feature with the endoscopic diagnosis.
The summary receiver operating characteristic curve method was used to summarize test characteristics across studies.
The team assessed individual alarm features when the study report permitted.
The researchers identified 83 of 2600 studies meeting the initial screening criteria.
Only 15 met inclusion criteria after detailed review.
These 15 studies evaluated a total of 57,363 patients, of whom 458 had cancer.
The team noted that sensitivity of alarm symptoms varied from 0% to 83% with considerable heterogeneity between studies.
The specificity also varied significantly from 40% to 98%.
The researchers found that a clinical diagnosis made by a physician was very specific but not very sensitive.
Dr Vakil's team concludes, “Alarm features have limited predictive value for an underlying malignancy.”
“Their use in dyspepsia management strategies needs further refinement and study.”