title: Alarm features and age for predicting upper gastrointestinal malignancy in Chinese patients with dyspepsia with high background prevalence of Helicobacter pylori infection and upper gastrointestinal malignancy: an endoscopic database review of 102,665 patients from 1996 to 2006.
abstract: OBJECTIVE
  Patients with dyspepsia with alarm features are suspected of having upper gastrointestinal (GI) malignancy; however, the true value of alarm features in predicting an underlying malignancy for patients with dyspepsia with high background prevalence of Helicobacter pylori infection and upper GI malignancy is uncertain. The aim of the present study was to determine the diagnostic accuracy of alarm features in predicting upper GI malignancy by reviewing an endoscopic database consisting of >100,000 Chinese patients.
  
  
  METHODS
  A retrospective analysis of prospectively collected data was conducted in a single tertiary medical centre. Consecutive patients who underwent oesophagogastroduodenoscopy (OGD) for dyspepsia in 1996-2006 were enrolled. The data including gender, age, symptoms, and endoscopic and pathological findings were analysed. The main outcome measure was the diagnostic accuracy of individual alarm feature.
  
  
  RESULTS
  102,665 patients were included in the final analysis. Among all the 4362 patients with malignancy, 52% (2258/4362) had alarm features. Among 15 235 patients who had alarm features, 2258 (14.8%) were found to have upper GI malignancy. The pooled sensitivity and specificity of the alarm features were 13.4% and 96.6%, respectively. Only the feature of dysphagia in patients between 36 and 74 years old had a positive likelihood ratio (PLR) >10 for malignancy prediction, while all other alarm features in other age groups had a PLR <10.
  
  
  CONCLUSIONS
  For uninvestigated Chinese patients with dyspepsia with high background prevalence of H pylori infection and upper GI malignancy, alarm features and age, except for dysphagia in patients between 36 and 74 years old, had limited predictive value for a potential malignancy; therefore, prompt endoscopy may be recommended for these patients. However, less invasive, inexpensive screening methods with high diagnostic yield are still needed to reduce unnecessary endoscopy workload.
authors.affiliation: Department of Gastroenterology, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Bai
authors.forename: Zhao-Shen
authors.initials: ZS
authors.lastname: Li
authors.forename: Duo-Wu
authors.initials: DW
authors.lastname: Zou
authors.forename: Ren-Pei
authors.initials: RP
authors.lastname: Wu
authors.forename: Yin-Zhen
authors.initials: YZ
authors.lastname: Yao
authors.forename: Zhen-Dong
authors.initials: ZD
authors.lastname: Jin
authors.forename: Ping
authors.initials: P
authors.lastname: Ye
authors.forename: Shu-De
authors.initials: SD
authors.lastname: Li
authors.forename: Wen-Jun
authors.initials: WJ
authors.lastname: Zhang
authors.forename: Yi-Qi
authors.initials: YQ
authors.lastname: Du
authors.forename: Xian-Bao
authors.initials: XB
authors.lastname: Zhan
authors.forename: Feng
authors.initials: F
authors.lastname: Liu
authors.forename: Jun
authors.initials: J
authors.lastname: Gao
authors.forename: Guo-Ming
authors.initials: GM
authors.lastname: Xu
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002681:China / Q000453:epidemiology; D004415:Dyspepsia / Q000453:epidemiology / Q000209:etiology*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D016481:Helicobacter Infections / Q000150:complications* / Q000453:epidemiology; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity