Are sinister symptoms useful in predicting serious endoscopic findings in dyspeptic patients?

Abstract

iNTRODUCTION: Early endoscopy is recommended for investigating dyspeptic patients when sinister symptoms are present. This is based upon the assumption that serious pathology will be more prevalent in patients with such symptoms. The association has never been validated prospectively. AIMS: To compare endoscopic findings in patients referred for investigation of dyspepsia with and without sinister symptoms. METHODS: As part of a large prospective trial, 923 patients aged 3kg, dysphegia, persistent vomiting, recent evidence of GI bleeding, family history of gastric cancer, history of gastric surgery. 215 patients had one or more of these sinister symptoms and were endoscoped. Of the 708 without sinister symptoms, half were randornised to endoscopic examination as part of the trial protocol. The endoscopic diagnosis in the 215 (mean age = 38y) with and 362 (mean age = 35y) without sinister symptoms was compared. RESULTS: Those with and without sinister symptoms had a similar prevalence of normal endoscopy (49% vs 56%), duodenal ulcer (6.9% ve 8.0%), gastric ulcer (4.4% vs 3.9%) and oesopbagitis Gd I (12.5% vs 13.3%) and Gd it (2.3% vs 2.0%) and gastric cancer (0% v 0%). In routine biopsies, low grade MALToma was found in one patient without, and subtotal villous atrophy in one patient with sinister symptoms. Serious oesophageal disease was the only finding more prevalent in those with (6/216) versus without (0/352) sinister symptoms (p<O.05). This consisted of Gd Ill oesophegitis, Barrett's oesophagus and oesophageal cancer in 2, 3 and 1 patient(s) respectively. Five of the 6 patients with severe oesophegeal pathology had dysphegia as their sinister symptom. Dyspbagla was reported by 39.5% of those with sinister symptoms. The prevalence of severe oesopbageal pathology (Gd III oesophagitis, Barrett's oesophagus or oesophegeal cancer) in those with dysphagia was 5/85 (6%). CONCLUSIONS: (1) In the absence of sinister symptoms, serious endoscopic pathology is very rare. (2) The presence of sinister symptoms is associated with an increased prevalence of serious oesophageal pathology (3) Dysphagia is the most important sinister symptom.