title: Performance of American Society for Gastrointestinal Endoscopy guidelines for dyspepsia in Saudi population: prospective observational study.
abstract: OBJECTIVE
  To evaluate adherence of primary care physicians (PCPs) to international guidelines when referring patients for upper-gastrointestinal endoscopy (UGE), evaluate the importance of alarm symptoms and the performance of the American Society for Gastrointestinal Endoscopy (ASGE) guidelines in a Saudi population.
  
  
  METHODS
  A prospective, observational cross-sectional study on dyspeptic patients undergoing UGE who were referred by PCPs over a 4 mo period. Referrals were classified as appropriate or inappropriate according to adherence to ASGE guidelines.
  
  
  RESULTS
  Total of 221 dyspeptic patients was enrolled; 161 patients met our inclusion criteria. Mean age was 40.3 years (SD ± 18.1). Females comprised 70.1%. Alarm symptoms included low hemoglobin level (39%), weight loss (18%), vomiting (16%), loss of appetite (16%), difficulty swallowing (3%), and gastrointestinal bleeding (3%). Abnormal endoscopy findings included gastritis (52%), duodenitis (10%), hiatus hernia (7.8%), features suggestive of celiac disease (6.5%), ulcers (3.9%), malignancy (2.6%) and gastroesophageal reflux disease (GERD: 17%). Among patients who underwent UGE, 63% met ASGE guidelines, and 50% had abnormal endoscopic findings. Endoscopy was not indicated in remaining 37% of patients. Among the latter group, endoscopy was normal in 54% of patients. There was no difference in proportion of abnormal endoscopic findings between two groups (P = 0.639).
  
  
  CONCLUSIONS
  Dyspeptic patients had a low prevalence of important endoscopic lesions, and none of the alarm symptoms could significantly predict abnormal endoscopic findings.
authors.affiliation: Nahla A Azzam, Majid A Almadi, Hessah Hamad Alamar, Lamis Atyah Almalki, Rehab Nawaf Alrashedi, Rawabi Saleh Alghamdi, Waleed Al-hamoudi, Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh 11461, Saudi Arabia.
authors.forename: Nahla A
authors.initials: NA
authors.lastname: Azzam
authors.affiliation: Nahla A Azzam, Majid A Almadi, Hessah Hamad Alamar, Lamis Atyah Almalki, Rehab Nawaf Alrashedi, Rawabi Saleh Alghamdi, Waleed Al-hamoudi, Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh 11461, Saudi Arabia.
authors.forename: Majid A
authors.initials: MA
authors.lastname: Almadi
authors.affiliation: Nahla A Azzam, Majid A Almadi, Hessah Hamad Alamar, Lamis Atyah Almalki, Rehab Nawaf Alrashedi, Rawabi Saleh Alghamdi, Waleed Al-hamoudi, Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh 11461, Saudi Arabia.
authors.forename: Hessah Hamad
authors.initials: HH
authors.lastname: Alamar
authors.affiliation: Nahla A Azzam, Majid A Almadi, Hessah Hamad Alamar, Lamis Atyah Almalki, Rehab Nawaf Alrashedi, Rawabi Saleh Alghamdi, Waleed Al-hamoudi, Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh 11461, Saudi Arabia.
authors.forename: Lamis Atyah
authors.initials: LA
authors.lastname: Almalki
authors.affiliation: Nahla A Azzam, Majid A Almadi, Hessah Hamad Alamar, Lamis Atyah Almalki, Rehab Nawaf Alrashedi, Rawabi Saleh Alghamdi, Waleed Al-hamoudi, Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh 11461, Saudi Arabia.
authors.forename: Rehab Nawaf
authors.initials: RN
authors.lastname: Alrashedi
authors.affiliation: Nahla A Azzam, Majid A Almadi, Hessah Hamad Alamar, Lamis Atyah Almalki, Rehab Nawaf Alrashedi, Rawabi Saleh Alghamdi, Waleed Al-hamoudi, Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh 11461, Saudi Arabia.
authors.forename: Rawabi Saleh
authors.initials: RS
authors.lastname: Alghamdi
authors.affiliation: Nahla A Azzam, Majid A Almadi, Hessah Hamad Alamar, Lamis Atyah Almalki, Rehab Nawaf Alrashedi, Rawabi Saleh Alghamdi, Waleed Al-hamoudi, Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh 11461, Saudi Arabia.
authors.forename: Waleed
authors.initials: W
authors.lastname: Al-hamoudi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004415:Dyspepsia / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D016099:Endoscopy, Gastrointestinal / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D016480:Helicobacter pylori / Q000302:isolation & purification; D006785:Hospitals, University; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D058007:Physicians, Primary Care / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012017:Referral and Consultation; D012529:Saudi Arabia / Q000453:epidemiology; D012955:Societies, Medical / Q000592:standards*; D019564:Unnecessary Procedures; D055815:Young Adult
keywords: American Society for Gastrointestinal Endoscopy guideline; Dyspepsia; Primary care physician; Saudi population; Upper gastrointestinal endoscopy