title: Incidence of gastroesophageal malignancy in patients with dyspepsia in Hong Kong: implications for screening strategies.
abstract: 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.
authors.affiliation: Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, NT, Hong Kong.
authors.forename: J J
authors.initials: JJ
authors.lastname: Sung
authors.forename: W C
authors.initials: WC
authors.lastname: Lao
authors.forename: M S
authors.initials: MS
authors.lastname: Lai
authors.forename: T H
authors.initials: TH
authors.lastname: Li
authors.forename: F K
authors.initials: FK
authors.lastname: Chan
authors.forename: J C
authors.initials: JC
authors.lastname: Wu
authors.forename: V K
authors.initials: VK
authors.lastname: Leung
authors.forename: Y W
authors.initials: YW
authors.lastname: Luk
authors.forename: N N
authors.initials: NN
authors.lastname: Kung
authors.forename: J Y
authors.initials: JY
authors.lastname: Ching
authors.forename: W K
authors.initials: WK
authors.lastname: Leung
authors.forename: J
authors.initials: J
authors.lastname: Lau
authors.forename: S J
authors.initials: SJ
authors.lastname: Chung
mesh_terms: 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*