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 25 May 2018

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Predicting upper GI malignancy with dyspepsia and Helicobacter pylori infection

Predicting upper GI malignancy in patients with dyspepsia and a high background prevalence of H pylori infection and upper gastrointestinal malignancy.

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Patients with dyspepsia with alarm features are suspected of having upper gastrointestinal (GI) malignancy.

However, the true value of alarm features in predicting an underlying malignancy for patients with dyspepsia with high background prevalence of Helicobacter pylori infection and upper gastrointestinal malignancy is uncertain.

Professor Zhao-Shen Li and colleagues from China determined the diagnostic accuracy of alarm features in predicting upper gastrointestinal malignancy by reviewing an endoscopic database consisting of more than 100,000 Chinese patients.

A retrospective analysis of prospectively collected data was conducted in a single tertiary medical centre.

Consecutive patients who underwent esophagogastroduodenoscopy for dyspepsia in 1996–2006 were enrolled.

The team analyzed data including gender, age, symptoms, and endoscopic and pathologastrointestinalcal findings.

The main outcome measure was the diagnostic accuracy of individual alarm feature.

52% had alarm features
Gut

The research team included 102,665 patients in the final analysis.

Among all the 4362 patients with malignancy, 52% had alarm features.

The researchers found that among 15,235 patients who had alarm features, 2258 had upper gastrointestinal malignancy.

The pooled sensitivity and specificity of the alarm features were 13% and 97%, respectively.

Only the feature of dysphagastrointestinala in patients between 36 and 74 years old had a positive likelihood ratio more than 10 for malignancy prediction, while all other alarm features in other age groups had a positive likelihood ratio less than 10.

Professor Li's team concluded, "For uninvestigated Chinese patients with dyspepsia with high background prevalence of H pylori infection and upper gastrointestinal malignancy, alarm features and age, except for dysphagastrointestinala in patients between 36 and 74 years old, had limited predictive value for a potential malignancy."

"Prompt endoscopy may be recommended for these patients."

"However, less invasive, inexpensive screening methods with high diagnostic yield are still needed to reduce unnecessary endoscopy workload."

Gut 2010:59(6):722-8
03 June 2010

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