Clinical Question: Which patients w...

Clinical Question: Which patients with dyspepsia should meet with urgent endoscopic evaluation?

Setting: Outpatient (specialty)

cogitation Design: Decision rule (validation)

Synopsis: Physicians in this inquiry which was conducted in England, had the option of referring patients for an pressing endoscopy if they felt it was indicated. Patients eligible for cogent endoscopy were those at least 55 years of age, those with alarm symptoms (eg dysphagia, anorexia, vomiting, weight los anemia), and those in whom individual or more high-risk features were instant (e.g., family history, Barrett's esophagus, pernicious anemia, peptic fester surgery, known dysplasia). A sample of 1852 patients was studied to identify the accuracy of predictors and to lay open a new set of criteria.

The alarm features greatest in quantity strongly associated with cancer were dysphagia, weight los and age of at least 55 years. For the prediction of any significant pathology (i.e., cancer, peptic boil stricture, esophagitis), age, dysphagia, and high-risk features were the strongest predictors. These proceeds were used to develop a of the present day set of criteria for pressing endoscopy: dysphagia or weight los at any age or charge of dyspepsia after 55 years of age associated with any alarm feature (eg anemia, anorexia, vomiting, dysphagia, weight loss)

The modern decision rule was validated in a following sample of 1,785 patients during the nearest 12 months. Of this assemblage 570 patients would not have required cogent endoscopy using the new criteria; 07 percent in this collection had cancer compared with 40 percent of the 1215 patients identified at the old rule as being at high risk.

Bottom Line: Patients with dysphagia or weight los at any age, as well as patients older than 55 years with any alarm symptoms or high-risk factors, should have importunate upper endoscopy to identify those who have cancer. However, plane in this large study, which discovered 70 upper gastrointestinal cancers, 60 percent of the findings were tumor, lymph node, or metastasis stage T3 or above, and barely 16 percent of patients were candidates for surgical resection. (Level of Evidence: 1b)

MARK EBELL, MD MS

cogitation Reference: Kapoor N, et al. Predictive value of alarm features in a rapid access upper gastrointestinal cancer service. take out the bowels of January 2005;54:40-5.

Used with permission from Ebell M Alarm factors, age > 55 increase risk of UGI malignancy. Accessed online March 31 2005 at: http://www.InfoPOEMs.com.

COPYRIGHT 2005 American Academy of Family Physicians

COPYRIGHT 2005 Gale Group