Are alarm symptoms valuable in predicting upper gastrointestinal malignancy?

Abstract

Background and Aims: The diagnostic utility of alarm symptoms in predicting upper gastrointestinal cancers is uncertain. In our study, we aimed to investigate the predictive value of alarm symptoms in the diagnosis of upper gastrointestinal cancers. Materials and Methods: This prospective observational study included patients with at least one or more alarm symptoms of upper gastrointestinal cancers who underwent esophagogastroduodenoscopy. Patients under 18 years of age and over 80 years of age were excluded. Patients were divided into two groups as under and over 45 years of age. Demographic characteristics, presenting complaints, alarm symptoms, endoscopy and pathology results were evaluated prospectively. Results: A total of 325 patients were included in the study, 62.5% of whom were female, with a mean age of 50.8 ± 15.8 years. The most common alarm symptoms were new-onset dyspepsia over 45 years of age (48.6%), weight loss (34.8%) and iron deficiency anemia (31.1%), respectively. In our study, malignancy was diagnosed in 8 patients (2.5%), 6 of whom were male, and all of whom were over 45 years of age. The alarm symptoms with the highest sensitivity were weight loss (75%) and iron deficiency anemia (50%), while the alarm symptoms with the highest specificity were palpable abdominal/epigastric mass or abnormal lymphadenopathy (96.5%) and upper gastrointestinal bleeding (96.2%). Conclusion: The sensitivity and specificity of alarming features in predicting upper gastrointestinal cancers is limited and other methods need to be developed to define the at-risk population.