imited Value of Alarm Features in the Diagnosis of Upper astrointestinal Malignancy : Systematic Review and Meta - nalysis

ackground & Aims: Alarm features such as dysphaia, weight loss, or anemia raise concern of an upper astrointestinal malignancy in patients with dyspepia. The aim of this study was to determine the diagostic accuracy of alarm features in predicting maligancy by performing a metaanalysis based on the ublished literature. Methods: English-language studes were identified by searching MEDLINE, EMBASE, ochrane Controlled Trials Register, and CINAHL. Coort studies that measured alarm features and comared them with the endoscopic findings were inluded. Studies were screened for inclusion by 2 uthors who independently extracted the data. Sensiivity, specificity, and likelihood ratios were calculated y comparing the alarm feature with the endoscopic iagnosis. The summary receiver operating characterstic curve method was used to summarize test charcteristics across studies. Individual alarm features ere also assessed when the study report permitted. esults: Eighty-three of 2600 studies met the initial creening criteria; 15 met inclusion criteria after deailed review. These 15 studies evaluated a total of 7,363 patients, of whom 458 (.8%) had cancer. The ensitivity of alarm symptoms varied from 0% to 83% ith considerable heterogeneity between studies. The pecificity also varied significantly from 40% to 98%. clinical diagnosis made by a physician was very pecific (range, 97%–98%) but not very sensitive range, 11%–53%). Conclusions: Alarm features have imited predictive value for an underlying malignancy. heir use in dyspepsia management strategies needs urther refinement and study.