Abstract
IntroductionDyspepsia is prevalent in the community. Guidelines recommend early endoscopy in dyspeptic patients who are older than 55 years, or have alarm features. There is a lack of data on endoscopy in patients with alarm features in Nigeria.MethodsA retrospective study of the endoscopic findings in adults with dyspepsia and alarm features, between August 1st 2017 and July 31st 2018 in Lagos, Nigeria. Data were analysed using Statistical Package for Social Sciences, version 23.0. The sensitivity, specificity, positive predictive value, and negative predictive value of the alarm features were calculated.ResultsOne hundred and fifty-nine gastroscopies were performed during this period, mean age was 47.8 (±14.4) years, 49.1% were male. Dyspepsia was the commonest indication for endoscopy (80.5%), 60.2% of the dyspeptics had at least one alarm feature. The most frequent dyspeptic symptom was epigastric pain/burning sensation (75%), while the commonest alarm features were recent onset dyspepsia in a patient over 45 years (79%) and unexplained weight loss (28.6%). Endoscopy was normal in 26%. The most frequent significant endoscopic findings were gastritis (49%) and gastric ulcer (17%) and they were not associated with alarm features. Upper gastrointestinal bleeding, persistent vomiting and odynophagia were specific for significant endoscopic findings. The pooled sensitivity, specificity, positive predictive value, and negative predictive value of the alarm features were 65%, 49%, 71% and 41% respectively.ConclusionPatients with dyspepsia and upper gastrointestinal bleeding, persistent vomiting or odynophagia, should be referred for prompt upper GI endoscopy.
Highlights
Dyspepsia is defined by the Rome criteria as chronic or recurrent pain or discomfort that is located in the upper abdomen, and includes symptoms such as early satiety, bloating, upper abdominal fullness or nausea [1]
Various guidelines recommend that dyspeptic patients over 55 years, and those with alarm features undergo prompt endoscopy to rule out peptic ulcer disease, oesophagogastric malignancy and other rare upper GIT disease [4, 5]
The common alarm features in patients with dyspepsia were recent onset dyspepsia in an adult older than 45 years, unexplained weight loss, dysphagia and upper gastrointestinal bleeding
Summary
Dyspepsia is defined by the Rome criteria as chronic or recurrent pain or discomfort that is located in the upper abdomen, and includes symptoms such as early satiety, bloating, upper abdominal fullness or nausea [1]. Some authors document a good predictive value of the alarm features in patients with dyspepsia when endoscopy is performed, and support the use of endoscopy in these patients [8,9,10]. Reports from Asia support endoscopic evaluation of dyspeptic patients older than 35 years even in the absence of alarm features [11]. Endoscopic findings that have been reported in adults over 45 years with these two features include erosive oesophagitis, Barrett's oesophagus, gastric or duodenal ulcer disease, and gastro-oesophageal malignancy [12]. The aim of this study was to describe the pattern of alarm features seen in adults with dyspepsia referred for endoscopy at two private facilities in Lagos and to document the endoscopic findings in these patients. The predictive value of alarm features in dyspeptic patients undergoing endoscopy was documented
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