| Is it possible to reduce endoscopy workload using age, alarm symptoms and H. pylori as predictors of peptic ulcer and oesophagogastric cancers? | |
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MedLine Citation:
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PMID: 15975541 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: We examined referrals to oesophagogastroduodenoscopy and the impact of demographic and clinical variables to predict major findings (peptic ulcer, cancer) on oesophagogastroduodenoscopy. METHODS: We collected data on 3669 consecutive patients referred for oesophagogastroduodenoscopy. RESULTS: Dyspeptic and reflux symptoms constituted 80% of oesophagogastroduodenoscopy referrals. A major finding was observed in 419 patients (11.4%). The mean age of cancer patients was 72.7 years (95% confidence interval (CI) 70.0-76.5 years) and that of peptic ulcer patients 62.0 years (95% CI 60.5-63.5 years). Independent risk factors for a major finding were age >50 years (odds ratio (OR) 1.62, 95% CI 1.24-2.10), male sex (OR 1.38, 95% CI 1.11-1.72), ulcer-type pain (OR 2.33, 95% CI 1.80-3.02), weight loss (OR 1.70, 95% CI 1.14-2.53), anaemia (OR 1.82, 95% CI 1.38-2.40), bleeding symptoms (OR 3.27, 95% CI 2.26-4.75) and Helicobacter pylori (OR 2.49, 95% CI 2.00-3.11), whereas reflux symptoms were protective (OR 0.73, 95% CI 0.53-1.00). The area under receiver operating characteristic curve of age over 50 years with alarm symptoms to predict major finding was 0.68 (95% CI 0.65-0.71), which positive H. pylori status increased to 0.71 (95% CI 0.69-0.74). Of the major findings, 87.2% were detected in patients with risk factors. Major findings were detected in 15.1% patients with and 8.1% (p < 0.001) without alarm symptoms. CONCLUSIONS: Dyspeptic and reflux symptoms constitute the majority of oesophagogastroduodenoscopy workload. Discriminative power of alarm symptoms even with positive H. pylori status to detect peptic ulcer or cancer was low. Because of their low cancer risk, reflux and dyspeptic patients younger than 50 years can be treated without oesophagogastroduodenoscopy. |
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Authors:
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M Voutilainen; T Mäntynen; K Mauranen; I Kunnamo; M Juhola |
Publication Detail:
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Type: Journal Article Date: 2005-03-29 |
Journal Detail:
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Title: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver Volume: 37 ISSN: 1590-8658 ISO Abbreviation: Dig Liver Dis Publication Date: 2005 Jul |
Date Detail:
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Created Date: 2005-06-24 Completed Date: 2005-10-20 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100958385 Medline TA: Dig Liver Dis Country: Netherlands |
Other Details:
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Languages: eng Pagination: 526-32 Citation Subset: IM |
Affiliation:
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Department of Internal Medicine, Jyväskylä Central Hospital, Finland. markku.voutilainen@ksshp.fi |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Age Factors Cross-Sectional Studies Endoscopy, Digestive System / utilization* Esophageal Neoplasms / diagnosis* Female Helicobacter pylori* Humans Male Middle Aged Multivariate Analysis Peptic Ulcer / diagnosis*, microbiology ROC Curve Referral and Consultation Stomach Neoplasms / diagnosis* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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