Auld, C.D.; Norrie, J.; McCole, D.; Seow, C.; Apollos, J.K.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA116
Academic Journal
Aim: To relate characteristics at presentation (symptoms, age and sex), to endoscopic findings to redefine referral guidelines. Methods: From a prospective database of > 9000 patients > 45 years (1994-2001), age, sex, and presentation (benign-pain/ dyspepsia and sinister-dysphagia, anaemia, vomiting, anorexia/ weight loss) and final endoscopic diagnoses were analysed. The odds ratio (OR) for presentation of benign findings and upper G.I. malignancy were determined by univariate and multivariate logistic regressions. Results: Overall 57% presented with benign symptoms, (dyspepsia 41%, pain 16%) and 43% with sinister symptoms (eg anaemia 16%, dysphagia 12%). Benign disease occurred in 71% with malignancy in 3%. Out of 256 cancer patients, the risk for males with benign symptoms increased with age from 0.7% < 55 years to 3.3% > 75 years. With sinister symptoms this ranged from 3.4% to 10% over the same age span. The findings were less marked in women. Using gender, incremental age and symptoms in a multivariate model OR varied from 0.96 for dyspepsia to 14.3 for dysphagia with the area under ROC curve 84%. 6201 patients had benign findings (oesophageal 41%, 42.7% gastric, 16.3% duodenal). Although statistically significant benign and sinister symptoms were unhelpful predictors for benign pathology. Multivariate analysis for oesophageal disease found dysphagia (OR 3.86) dyspepsia (OR 1.97) significantly associated with outcome (p < 0.0001). Similarly haematemesis had increased odds of a benign duodenal finding while anaemia (OR 0.55) and dysphagia (OR 0.31) were negative predictors. For benign gastric findings dysphagia was a negative predictive outcome. Conclusion: Although this data support the concept of increasing age for endoscopy in patients with benign symptoms to exclude cancer, the predictability of benign pathology, including premalignant conditions is difficult to determine from age, sex, and presentation.


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