title: Diagnostic value of symptoms of oesophagogastric cancers in primary care: a systematic review and meta-analysis.
abstract: BACKGROUND
  Selection of primary care patients for investigation of potential oesophagogastric cancer is difficult, as the symptoms may represent benign conditions, which are also more common.
  
  
  OBJECTIVE
  To review systematically the presenting features of oesophagogastric cancers in primary care, including open-access endoscopy clinics.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  MEDLINE®, Embase, the Cochrane Library, and CINAHL were searched for studies of adults who were symptomatic and presented in primary care or open-access endoscopy clinics. Exclusions were being asymptomatic, screening, or recurrent cancers. Data were extracted to estimate the diagnostic performance of features of oesophagogastric cancers and summarised in a meta-analysis.
  
  
  RESULTS
  Fourteen studies were identified. The strongest summary sensitivity and specificity estimates were for: dyspepsia 0.42 (95% confidence interval [CI] 0.29 to 0.56) and 0.48 (95% CI = 0.31 to 0.65); pain 0.41 (95% CI = 0.24 to 0.62) and 0.75 (95% CI = 0.51 to 0.89); and dysphagia 0.32 (95% CI = 0.17 to 0.52) and 0.92 (95% CI = 0.81 to 0.97). Summary positive likelihood ratios (LR+) and diagnostic odds ratios were: dyspepsia 0.79 (95% CI = 0.55 to 1.15) and 0.65 (95% CI = 0.32 to 1.33); pain 1.64 (95% CI = 1.20 to 2.24) and 2.09 (95% CI = 1.57 to 2.77); and dysphagia 4.32 (95% CI = 2.46 to 7.58) and 5.91 (95% CI = 3.56 to 9.82). Sensitivity was lower for: anaemia 0.12 [95% Cl = 0.08 to 0.19] with specificity 0.97 [95% Cl = 0.94 to 0.99]; nausea/vomiting/bloating 0.17 [95% Cl = 0.05 to 0.46] and 0.84 [95% Cl = 0.60 to 0.94] respectively; reflux 0.23 [95% Cl = 0.10 to 0.46] and 0.70 [95% Cl = 0.59 to 0.80]; weight loss 0.25 [95% Cl = 0.12 to 0.43] and 0.96 [95% Cl = 0.88 to 0.98]. [corrected]. Corresponding LR+ were: anaemia 4.32 (95% CI = 2.64 to 7.08); nausea/vomiting/bloating 1.07 (95% CI = 0.52 to 2.19); reflux 0.78 (95% CI = 0.47 to 1.78) and; weight loss 5.46 (95% CI = 3.47 to 8.60).
  
  
  CONCLUSIONS
  Dysphagia, weight loss, and anaemia show the strongest association but with relatively low sensitivity and high specificity. The findings support the value of investigation of these symptoms, but also suggest that, in a population of patients who are low risk but not no-risk, investigation is not currently recommended.
authors.affiliation: NIHR Centre for Academic Primary Care, University of Bristol. Bristol.
authors.forename: Margaret P
authors.initials: MP
authors.lastname: Astin
authors.affiliation: University of Exeter Medical School, Exeter.
authors.forename: Tanimola
authors.initials: T
authors.lastname: Martins
authors.affiliation: NIHR Centre for Academic Primary Care, University of Bristol. Bristol.
authors.forename: Nicky
authors.initials: N
authors.lastname: Welton
authors.affiliation: North Wales Centre for Primary Care Research, Bangor University, Wrexham.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Neal
authors.affiliation: Department of Primary Care and Public Health, University of Oxford, Oxford.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Rose
authors.affiliation: University of Exeter Medical School, Exeter.
authors.forename: William
authors.initials: W
authors.lastname: Hamilton
mesh_terms: D003680:Deglutition Disorders / Q000209:etiology / Q000473:pathology*; D004724:Endoscopy / Q000379:methods; D004938:Esophageal Neoplasms / Q000175:diagnosis*; D004943:Esophagogastric Junction / Q000473:pathology*; D006801:Humans; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000175:diagnosis*; D015431:Weight Loss
keywords: diagnosis; oesophageal neoplasms; primary health care; stomach neoplasms; symptom; systematic review