The Diagnostic Value of Alarm Features for Identifying Types and Stages of Upper Gastrointestinal Malignancies

BACKGROUND Upper gastrointestinal (GI) malignancies are an uncommon cause of dyspepsia but of great concern. The aim of this study was to determine the association between alarm features and each type and stage of upper GI malignancies. METHODS Patients who underwent endoscopy for symptoms of dyspepsia between January 2008 and December 2009 were retrospectively collected. Alarm features studied in this study were dysplasia, body weight loss and GI bleeding. Patients were classified according to the findings of endoscopy and histological reports. RESULTS A total of 3,926 patients were included in the study, with 82 (2.1%) cases with GI malignancies. The specificity and negative predictive value of alarm features ranged from 93.8% to 99.8%, but the sensitivity and positive predictive value ranged from 11.6% to 29.3%. The only variable with a positive predictive value was dysphagia (66.7%). The patients with esophageal cancers and upper gastric cancers had the highest ratio of alarm features, most body weight loss and dysphagia. There was a positive correlation between alarm features and advanced stages of gastric cancers, with the exception of GI bleeding sign. CONCLUSION Although alarm features had a low sensitivity in identifying patients with upper GI malignancies, the presence of alarm features did help diagnose esophageal or upper gastric cancer and the sign of GI bleeding for early gastric cancer. In addition, dysphagia and weight loss are associated with higher stages of gastric cancer.