Original Articles
Diagnostic yield of upper endoscopy in Asian patients presenting with dyspepsia

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Abstract

Background: The aim of this study was to determine the frequency of diagnosis of significant disease by EGD in Asian patients of various ages with simple dyspepsia. Methods: Database records of 10,488 consecutive patients undergoing EGD between 1992 and 1998 were analyzed. The frequency of significant upper GI disease (defined as esophagitis, peptic ulcer, and cancer) in patients presenting with simple dyspepsia was determined for various age groups. Results: For the indication simple dyspepsia, 5066 (48.3%) EGDs were performed. At 988 (19.5%) EGDs, significant disease was noted (peptic ulcer 14.9%, esophagitis 5.0%, stomach cancer 0.47%, esophageal cancer 0.06%). There was a positive correlation between disease frequency and increasing age. The cumulative percentages of significant disease by age group were as follows: 10.8% in patients less than 35 years of age, 11.9% for those less than 40 years old, 13.7% for patients less than 45 years of age, and 19.5% overall. The cumulative frequencies of gastric cancer by age group were as follows: 0.68 of 1000 EGDs in patients less than 35 years of age, 1.15 of 1000 EGDs in patients less than 45 years old, and 9.60 of 1000 EGDs in patients greater than 45 years of age. Conclusion: The present study provides data to assist decision-making regarding the use of EGD in the patient population of Singapore. For patients with simple dyspepsia residing in Singapore, an age threshold of 45 years is reasonable inasmuch as gastric cancer is rarely found at endoscopy in younger patients. The age threshold for EGD for simple dyspepsia for Asians residing in other parts of the world would have to be determined based on the local prevalence of gastric cancer. (Gastrointest Endosc 2002;56:548-51.)

Section snippets

Patients and methods

Endoscopy, rather than barium contrast radiography, is the primary mode in our division for investigation of dyspepsia, which is defined as pain and discomfort centered in the upper abdomen.6 Clinical data including demographic characteristics, indications for EGD and findings for all patients undergoing upper endoscopy at our hospital in Singapore were prospectively recorded on standard forms and entered into a computer database. The patient population consisted mainly of ambulatory patients

Results

A total of 10,488 EGDs were performed over the 7-year period of the study. The indications were simple dyspepsia in 5066 patients (48.3%), hematemesis and/or melena in 1250 (11.9%), anemia/positive fecal occult blood test in 1097 (10.5%), follow-up of gastric ulcer in 707 (6.7%), dysphagia/vomiting in 445 (4.2%), weight loss in 186 (1.8%), atypical chest pain in 182 (1.7%), and other in 555 (14.8%). A total of 5066 patients (men 2356 [46.5%], women 2710 [53.5%]; median age 45 years, range 12-97

Discussion

Studies of white patients with simple dyspepsia have found an extremely low frequency of stomach cancer in patients below 45 years of age. A study from the United Kingdom that included 686 patients found no malignant disorders in patients less than 45 years old with simple dyspepsia.9 Another study from Canada found only 3 cases of gastric cancer among 3634 patients with simple dyspepsia.10 The investigators concluded that a strategy of initial noninvasive management was unlikely to negatively

Acknowledgements

We would like to thank Ms Janice Choo, Assistant Manager of Medical Records Office, National University Hospital, Professor K. Shanmugaratnam, Director of Singapore Cancer Registry, and staff of the Department of Pathology, National University of Singapore for their assistance in data retrieval, and Mr. Ivan Ho for his assistance in compilation of endoscopic data.

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Reprint requests: Khay G. Yeoh, MBBS, Division of Gastroenterology, Department of Medicine, National University Hospital, Lower Kent Ridge Rd., Singapore 119074, Lower Kent Ridge Road, Singapore 119074.

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