Incidence of gastroesophageal malignancy in patients with dyspepsia in Hong Kong: implications for screening strategies.
BACKGROUND
A "test-and-treat" strategy for H pylori infection has been recommended in Europe and North America as safe and cost-effective for management of patients with dyspepsia. The primary aim of this study was to determine the frequency of gastroesophageal cancer in 2 groups of patients with dyspepsia: those 45 years of age or younger without "alarm" symptoms (low-risk group) and patients over 45 years of age or any patient with "alarm" symptoms (high-risk group). A secondary aim was to determine the frequency of gastric cancer among patients in the low-risk group with or without a positive serology for H pylori.


METHODS
Patients with persistent dyspepsia were recruited from 4 regional hospitals in Hong Kong. Those in the low-risk group were evaluated for H pylori by using a whole blood serology test; they underwent endoscopy within 1 week. Those in the high-risk group and those taking nonsteroidal anti-inflammatory drugs (NSAIDs) underwent endoscopy promptly. Alarm symptoms were as follows: weight loss (10 or more pounds over 8 weeks), recurrent vomiting, dysphagia, bleeding, or anemia.


RESULTS
Of 2627 patients enrolled, 1017 were in the low-risk group and 1610 in the high-risk group. Twenty-three patients (0.9%) had gastroesophageal cancers (20 gastric, 3 esophageal). Four patients with cancer (17.4%) were in the low-risk group (3 gastric, 1 esophageal); all except the patient with esophageal cancer had a positive serology test. In the high-risk group, 19 patients had cancer (17 gastric, 2 esophageal).


CONCLUSIONS
Gastric cancer is relatively frequent among young patients with dyspepsia who have no alarm features in Hong Kong. This finding raises concerns as to the safety of the "test-and-treat" strategy for the management of patients with dyspepsia in Asia.
Sung
J J
JJ
Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, NT, Hong Kong.
Lao
W C
WC
Lai
M S
MS
Li
T H
TH
Chan
F K
FK
Wu
J C
JC
Leung
V K
VK
Luk
Y W
YW
Kung
N N
NN
Ching
J Y
JY
Leung
W K
WK
Lau
J
J
Chung
S J
SJ
D000328:Adult; D004415:Dyspepsia / Q000453:epidemiology*; D004938:Esophageal Neoplasms / Q000453:epidemiology*; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000453:epidemiology*