Prevalence of Clinically Significant Endoscopic Findings in Dys- peptic Patients with Alarm Features

Background: Dyspepsia is common in clinical practice. Esophagogastroduodenoscopy (EGD) is generally recommended in dyspeptic patients with alarm features (AF) including (I) age_55 years, (II) evidence of gastrointestinal blood loss, (III) unexplained weight loss, (IV) dysphagia, and (V) persistent vomiting. The predictive value of AF remains uncertain. Aims: To evaluate EGD findings in dyspeptic patients with AF and to assess the diagnostic role of abdominal ultrasonography (US) in endoscopy-negative dyspeptic patients with AF. Methods: Between March 2012 and January 2013, consecutive dyspeptic patients were screened for the presence of AF. EGD was performed in 227 dyspeptic patients with AF. Significant EGD findings were defined as any lesion(s) other than normal and non-erosive gastritis. Patients with known intraabdominal malignancy, previous gastric surgery and previous EGD were excluded. EGD findings among dyspeptic patients without AF who underwent EGD during the same period of time was retrospectively collected to compare with the study population. Abdominal US was performed in all endoscopy-negative patients. Results: Peptic ulcer disease and erosive gastroduodenitis were found in 18.5% and 44.1% of patients respectively. H. pylori infectionwas found in 52.9% (117/221). GI tumors were encountered in 6.1% (cancer of the esophagus 1, cancer of the stomach 8, gastric lymphoma 2, GIST 2, metastatic squamous cell cancer of the 1). Significant findings were found in 69.2% (157/227) of patients; and this was significantly higher than in the AFnegative dyspeptic cohort. (69.2% vs 21.3%, p<0.001). Among 5 AF, persistent vomiting seemed to have the highest predictive value, especially for peptic ulcer (60%). Male sex, GI blood loss, vomiting, age ≥ 55 with GI blood loss, GI blood loss with weight loss and H. pylori infection were associated with significant EGD findings. In those 70 patients with negative EGD, US was performed in 64 patients and was normal in 51.6% and positive in 48.4% (fatty liver 14, gallstones 13, lymphadenopathy 1, cholangiocarcinoma 1,hemangioma 1, intrahepatic duct