The researchers evaluated the effectiveness of age and 'alarm' symptoms for predicting major endoscopic findings, in six practicing endoscopy centers.
They reported their findings in the July issue of Gut.
Clinical variables of consecutive patients with dyspepsia symptoms, who were undergoing upper endoscopy examinations were recorded using a common endoscopy database.
3,815 patients, who had no previous upper endoscopy or barium radiography, were included.
Stepwise multivariate logistic regression was used to identify predictors of endoscopic findings. The accuracy of these for predicting endoscopic findings was evaluated, with receiver operating characteristic analysis.
In addition, the sensitivity and specificity of age thresholds, from 30 to 70 years, were evaluated.
| Age and alarm symptoms in predicting endoscopic outcome:|
Major pathology (tumor, ulcer, or stricture) was found at endoscopy in 787 (21%) patients with dyspepsia.
Age, male sex, bleeding, and anemia were all found to be significant - but weak - independent predictors of endoscopic findings.
The researchers found that a multivariate prediction rule, based on these factors, had poor predictive accuracy.
Using a simplified prediction rule, of age 45 years or over or the presence of any 'alarm' symptom, sensitivity and specificity were found to be 87% and 26%, respectively.
Increasing or decreasing the age cut-off did not significantly improve the predictive accuracy.
Investigator Michael Wallace, of the Digestive Disease Center, Medical University of South Carolina, concluded on behalf of fellow authors, Age and the presence of 'alarm' symptoms are not effective predictors of endoscopic findings among patients with dyspepsia.
"Better clinical prediction strategies are needed to identify patients with significant upper gastrointestinal pathology."