Abstract
BackgroundPatients with malignant tumours of the upper gastrointestinal tract tumours exhibit important alarm symptoms such as dysphagia that warrant clinical investigations. An endoscopic examination of the upper gastrointestinal tract will be required in most cases. This study evaluates the diagnostic potential of index endoscopy in a random population of patients with dysphagia.MethodsThis is a retrospective analysis of prospectively collected data over 10 years. Patients with previous endoscopic evaluation or upper gastrointestinal pathology were excluded from the study. Data was analysed to see the number and frequency of abnormal findings in upper gastrointestinal tract, and their significance in relation to the presenting symptoms.ResultsTotal number of index endoscopies was 13, 881. 913 patients were included in the study including 465 males (age range: 17–92 years, median: 55 years) and 448 females (age range: 18–100, median: 59 years), with male to female ratio of 1.04: 1. Oesophagus was abnormal in 678 cases (74%) and biopsies were taken in 428 patients (47%). Superficial oesophagitis, Barrett's oesophagus, oesophageal cancer, and oesophageal ulcer were main histological findings. Age more than 50 years and weight loss were significant predictors of oesophageal cancer (p < 0.0001). Male gender, heartburn, epigastric pain, weight loss and vomiting were significantly related to Barrett's oesophagus. A total of 486 gastric and 56 duodenal biopsies were also taken. There were 20 cases of gastric adenocarcinoma.ConclusionOGD is an effective initial investigation to assess patients with dysphagia, especially males above the age of 50 years. Patients may be started on treatment or referred for further investigations, for example, a barium meal in the absence of any anatomical abnormality.
Highlights
Patients with malignant tumours of the upper gastrointestinal tract tumours exhibit important alarm symptoms such as dysphagia that warrant clinical investigations
Most patients with dysphagia referred to the surgical clinics have oesophageal causes, and an endoscopic examination of the upper GI tract as first line examination will be required in these cases
We evaluated the diagnostic potential of OGD and looked at the nature and frequency of different upper GI conditions, benign and malignant, diagnosed on index OGDs in a random population of patients referred primarily with dysphagia
Summary
Patients with malignant tumours of the upper gastrointestinal tract tumours exhibit important alarm symptoms such as dysphagia that warrant clinical investigations. Dysphagia typically refers to difficulty in eating as a result of disruption in the swallowing process. It is an important alarm symptom, especially when associated with other upper gastrointestinal (GI) symptoms like dyspepsia, chronic gastrointestinal bleeding, progressive unintentional weight loss, persistent vomiting, iron deficiency anaemia or epigastric mass. Most patients with dysphagia referred to the surgical clinics have oesophageal causes, and an endoscopic examination of the upper GI tract (oespphago-gastro-duodenoscopy; OGD) as first line examination will be required in these cases
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