Timing of endoscopy in dyspepsia: not so simple ▸

Overuse of endoscopy in countries where gastric cancer (GC) is uncommon is not cost effective, with guidelines recommending “test and treat” strategies and age thresholds for endoscopy of 45 or 55 years in the absence of alarm symptoms. Whether this is appropriate for countries with a higher prevalence of GC is unclear. The authors prospectively studied all dyspeptic patients undergoing open access endoscopy over five years to study the age distributions of GC cases and compared the prevalence of early and advanced cases in those with “simple” dyspepsia versus those with alarm symptoms. Of 461 cancers, 45 (10%) were in <45 and 5% were in <40 year olds. GC occurred in 12.6/1000 patients presenting with uninvestigated dyspepsia, 51% of whom had no alarm symptoms. Patients without alarm symptoms were more likely to have early cancer than those with alarm symptoms (p = 0.002) and 12/225 (5.3%) of cases would have been missed had an age cut off of 45 years for simple dyspepsia been implemented. Lessons? Early GC …