Casburn-Jones, A.C.; Gillen, D.; McColl, K.E.L.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA33
Academic Journal
Most guidelines recommend endoscoping patients over 55 years of age with uncomplicated dyspepsia. This rationale is based on the assumption that an upper gastrointestinal (Gl) cancer may be detected at a curable stage in such patients. Aim: To determine the proportion of upper Gl cancers that present with uncomplicated dyspepsia in patients ≥ 55 years and determine the proportion of these upper Gl cancers that are curable. Method: We reviewed the case notes of patients within a catchment area of the North Glasgow Trust, population of approximately 300 000, who were ≥ 55 years age, diagnosed with an upper Gl cancer between October 1995 and December 1998 inclusive. These patients were identified by the West of Scotland Cancer Registry. Presenting symptoms were taken to be those recorded as present at the time of referral for initial investigation. Results: Of the 106 cancer cases identified only 23.5% (24) had dyspepsia (complicated or uncomplicated) as their predominant SddYymptom. Only 8.5% (9) of patients presented with uncomplicated dyspepsia. Of those 9 patients presenting with uncomplicated dyspepsia and found to have upper Gl cancer, 6 were found to have lymph node metastases and/or extensive metastases at the time of diagnosis. Each of these 6 patients died from their cancer between 3 and 26 months from diagnosis. Onepatient had no record of lymph node spread but died 55 days after diagnosis. Of the 2 patients presenting with simple dyspepsia without evidence of lymph node spread, 1 died 57 days post-diagnosis from post-gastrectomy complications. Only 1 patient presenting with simple dyspepsia and found to have cancer remains alive at 5 years follow up. Conclusion: A policy of endoscoping patients ≥ 55 years with simple dyspepsia will reduce death from upper Gl cancers by less than 1% in our population.


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