Use of alarm symptoms to select dyspeptics for endoscopy causes patients with curable esophagogastric cancer to be overlooked

• Published in: Surgical endoscopy Vol. 20; no. 11; pp. 1725 - 1728
• Main Authors: Bowrey, D. J., Griffin, S. M., Wayman, J., Karat, D., Hayes, N., Raimes, S. A.
• Format: Journal Article
• Language: English
• Published: New York, NY Springer 01.11.2006; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Databases as Topic; Digestive system. Abdomen; Dyspepsia - etiology; Endoscopy; Endoscopy, Digestive System; Esophageal Neoplasms - complications; Esophageal Neoplasms - diagnosis; Esophageal Neoplasms - pathology; Female; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Neoplasm Staging; Other diseases. Semiology; Practice Guidelines as Topic; Prospective Studies; Referral and Consultation; Stomach Neoplasms - complications; Stomach Neoplasms - diagnosis; Stomach Neoplasms - pathology; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Human; Carcinoma; Anemia; Dyspepsia; Esophageal disease; Esophagogastric cancer; Hemopathy; Gastroscopy; Metastasis; Malignant tumor; Medicine; Symptomatology; Treatment; Vomiting; Surgery; Digestive diseases; Dysphagia; Cancer
• DOI: 10.1007/s00464-005-0679-3
• ISSN: 0930-2794; 1432-2218

In August 2004, the United Kingdom Department of Health advisory body published dyspepsia referral guidelines for primary care practitioners. These guidelines advised empiric treatment with antisecretory medications and referral for endoscopy only in the presence of alarm symptoms. The current study aimed to evaluate the effect of these guidelines on the detection of esophagogastric cancer. The study reviewed a prospectively compiled database of 4,018 subjects who underwent open access gastroscopy during the years 1990 to 1998. The main outcome measures for the study were cancer detection rates, International Union Against Cancer (UICC) stage, and survival. Gastroscopy identified esophagogastric carcinoma in 123 (3%) of the 4,018 subjects. Of these 123 patients, 104 (85%) with esophagogastric cancer had "alarm" symptoms (anemia, mass, dysphagia, weight loss, vomiting) and would have satisfied the referral criteria. The remaining 15% would not have been referred for initial endoscopic assessment because their symptoms were those of uncomplicated "benign" dyspepsia. The patients with "alarm" symptoms had a significantly more advanced tumor stage (metastatic disease in 47% vs 11%; p < 0.001), were less likely to undergo surgical resection (50% vs 95%; p < 0.001), and had a poorer survival (median, 11 vs 39 months; p = 0.01) than their counterparts without such symptoms. The use of alarm symptoms to select dyspeptics for endoscopy identifies patients with advanced and usually incurable esophagogastric cancer. Patients with early curable cancers often have only dyspeptic symptoms, and their diagnosis will be delayed until the symptoms of advanced cancer develop.