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Dyspepsia with alarm symptoms in patients aged less than 60 years: Is upper gastrointestinal endoscopy justified in Indian scenario?

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Abstract

Background

Newer American College of Gastroenterology (ACG) and Canadian Association of Gastroenterology (CAG) guidelines do not suggest endoscopy to investigate alarm features for dyspepsia patients under the age of 60 to exclude upper gastrointestinal (GI) neoplasia. The validity of this recommendation has not been evaluated in our population. So, this study was conducted to assess the utility of upper GI endoscopy to investigate alarm features in dyspepsia patients less than 60 years of age to exclude upper GI neoplasia.

Methods

This prospective observational study evaluated consecutive patients of dyspepsia between 18 and 60 years of age, with at least one or more of the alarm symptoms (unintentional weight loss; loss of appetite; GI bleeding; anemia; recurrent or persistent vomiting; dysphagia with predominant epigastric pain; and family history of upper GI cancer) with upper GI endoscopy to exclude any organic lesion and malignancy.

Results

Of total 294 patients evaluated with endoscopy, 34.7% (n=102) had normal endoscopy (functional dyspepsia [FD]) while 65.3% (n=192) had abnormal endoscopic findings (organic dyspepsia [OD]). Of 192 patients with OD, 146 patients (49.6% of the total study population) had benign abnormality (benign OD) while 46 patients (15.6% of the total study population) had malignancy of the upper GI tract (malignant OD).

Conclusion

The investigation of alarm features in dyspepsia patients less than 60 years of age with upper GI endoscopy leads to detection of organic lesion (65.3%) including malignancy (15.6%) in a significant percentage of patients.

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Authors and Affiliations

  1. Department of Medicine, Indira Gandhi Medical College and Hospital, Shimla, 171 001, India

    Priya Kumari & Prem Machhan

  2. Department of Gastroenterology, Indira Gandhi Medical College and Hospital, Shimla, 171 001, India

    Brij Sharma, Rajesh Sharma, Vishal Bodh & Rajesh Kumar

Authors
  1. Priya Kumari
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  2. Prem Machhan
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  3. Brij Sharma
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  4. Rajesh Sharma
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  5. Vishal Bodh
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  6. Rajesh Kumar
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Contributions

Study concept and protocol design: Prem Machhan, Brij Sharma, Vishal Bodh, Rajesh Sharma. Collection and analysis of data: Priya Kumari, Rajesh Kumar, Vishal Bodh. Preparing initial draft of the manuscript: Vishal Bodh, Prem Machhan, Brij Sharma. Critical revision of the manuscript: Vishal Bodh, Rajesh Sharma. Obtained funding: None. Administrative, technical, and material support: Brij Sharma, Prem Machhan, Vishal Bodh. Study supervision: Brij Sharma, Prem Machhan, Vishal Bodh, Rajesh Sharma.

Corresponding author

Correspondence to Vishal Bodh.

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Conflict of interest

PK, PM, BS, RS, VB, and RK  declare that they have no conflict of interest.

Ethics approval

The study was performed conforming to the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

Approval from the ethical committee of our institution was taken for this study. All patients provided written consent prior to the procedure.

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The authors are solely responsible for the data and the contents of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, the Indian Society of Gastroenterology, or the printer/publishers are responsible for the results/findings and content of this article.

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Kumari, P., Machhan, P., Sharma, B. et al. Dyspepsia with alarm symptoms in patients aged less than 60 years: Is upper gastrointestinal endoscopy justified in Indian scenario?. Indian J Gastroenterol 41, 430–439 (2022). https://doi.org/10.1007/s12664-022-01275-y

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  • DOI: https://doi.org/10.1007/s12664-022-01275-y

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