With the advent of empirical treatment strategies for patients with dyspeptic symptoms, it becomes increasingly important to select patients with a high risk of having cancer for immediate endoscopy.
Usually alarming symptoms are used for this matter, but their diagnostic value is by no means clear.
Dr Fransen and colleagues from the Netherlands designed a study in order to investigate the diagnostic value of alarm symptoms for upper gastrointestinal malignancy.
The researchers identified studies describing prevalence of alarm symptoms in patients with and without endoscopically verified upper gastrointestinal malignancy using a Medline search.
The research group then calculated the prevalence, pooled sensitivity, specificity, positive and negative predictive values.
|Mean prevalence of gastrointestinal malignancies in the cohort studies was 2.8% of 16 161 patients|
|Alimentary Pharmacology and Therapeutics|
In total, the research team selected about 17 case studies and 9 cohort studies.
The researchers found that the mean prevalence of gastrointestinal malignancies in the cohort studies was 2.8% of 16 161 patients.
5 cohort studies reviewed by the research team indicated that 25% of the patients diagnosed with upper gastrointestinal malignancy had no alarm symptoms.
The researchers noted that the pooled sensitivities of individual alarm symptoms varied from 9 to 41%, the pooled positive predictive value ranged from 5 to 8 %, and was 6% for 'having any alarm symptom'.
The pooled negative predictive value was 99.4% for 'having any alarm symptom'.
Dr Fransen concluded, "The risk of upper gastrointestinal malignancy in any individual without alarm symptoms is very low, but approximately 1/4 patients with upper gastrointestinal cancer have no alarm symptoms at the time of diagnosis."