title: Can clinical features stratify use of endoscopy for dyspeptic patients with high background prevalence of upper gastrointestinal cancer?
abstract: BACKGROUND
  Whether clinical features can stratify priority of endoscopy remains controversial for dyspeptic patients with high background prevalence of upper gastrointestinal cancer.
  
  
  OBJECTIVE
  To examine the predictive performance of clinical features for cancerous lesions in dyspeptic patients in Taiwan.
  
  
  METHODS
  Between April 2008 and July 2009, 2530 consecutive dyspeptic outpatients underwent prospective evaluation with standardized questionnaire and then upper gastrointestinal endoscopy. Performance of using age thresholds and alarm symptoms to predict malignancy was determined. Independent risk factors associated with malignancy and those with negative endoscopic findings were identified.
  
  
  RESULTS
  Malignant lesions were found in 31 patients (1.2%) and were independently associated with age, male gender, gastrointestinal bleeding, weight loss, and alcohol consumption. Any symptom of weight loss, bleeding and dysphagia, or simply age >45 years predicted 97% of cancer cases, with the sensitivity, specificity, positive and negative predictive values being 96.8%, 29.3%, 1.7%, and 99.9%, respectively. This strategy achieved a low negative likelihood ratio (0.11) and a high diagnostic odds ratio (12.45). Negative endoscopic finding (n=1377, 54.4%) was independently associated with younger age, female gender, no use of non-steroidal anti-inflammatory drug, and no tobacco or alcohol consumption.
  
  
  CONCLUSIONS
  Absence of weight loss, dysphagia, and gastrointestinal bleeding predicts low likelihood of malignancy in dyspeptic Taiwanese patients aged <45 years.
authors: Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.
authors: Yao-Chun
authors: YC
authors: Hsu
authors: Tzeng-Huey
authors: TH
authors: Yang
authors: Jyh-Ming
authors: JM
authors: Liou
authors: Wei-Lun
authors: WL
authors: Hsu
authors: Hwai-Jeng
authors: HJ
authors: Lin
authors: Huei-Tang
authors: HT
authors: Wu
authors: Jaw-Town
authors: JT
authors: Lin
authors: Hsiu-Po
authors: HP
authors: Wang
authors: Ming-Shiang
authors: MS
authors: Wu
mesh_terms: D000367:Age Factors; D000428:Alcohol Drinking; D003680:Deglutition Disorders / Q000209:etiology; D004415:Dyspepsia / Q000150:complications / Q000175:diagnosis*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D005770:Gastrointestinal Neoplasms / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013624:Taiwan; D015431:Weight Loss