Incidence of gastroesophageal malignancy in patients with dyspepsia in Hong Kong: Implications for screening strategies

Alarm features and age for predicting upper gastrointestinal malignancy in Chinese patients with dyspepsia with high background prevalence of Helicobacter pylori infection and upper gastrointestinal malignancy: an endoscopic database review of 102 665 patients from 1996 to 2006

“…However, the prevalence of peptic ulcers remained stable in all age groups (∼20%) in our case series, and this finding was in contrast to several studies32 33 where the prevalence of peptic ulcers was age dependent; it is not clear what accounts for this difference. The prevalence of upper GI malignancy in our study (4.2%) was relatively higher than that of the study in Hong Kong10 (0.9%, 23/2627) and that in Taiwan9 (1.25%, 225/17894). We consider that the reason for this difference is that Shanghai has a prevalence of gastric cancer, with an age-standardised incidence rate (per 100 000 per year) of 34.3 in males and 18.9 in females,19 respectively, which is 1.8-fold higher than that of Taiwan.…”

“…Thirdly, due to the large sample size of the present study, the number of malignancies detected was quite large (4362 patients); therefore, we had enough statistical power to detect some important difference among various age groups which otherwise may be missed because of a small number of patients. Finally, though similar studies has been reported from Chinese Hong Kong and Chinese Taiwan9 10 where the prevalence of upper GI cancer is also high, none of these studies documented the details of diagnostic accuracy of the individual alarm features, and Liou et al considered alarm features as a whole but did not focus on individual alarm features9; therefore, the present study may be the largest study evaluating the diagnostic accuracy of individual alarm feature in patients of various age groups who had a high background prevalence of H pylori infection and upper GI cancer.…”

“…However, studies from areas with a high background prevalence of gastric cancer demonstrated that 0.4–5% of gastric cancers would have been missed if endoscopy had not been offered9 10; another study from Shanghai also suggested both H pylori ‘test and treat’ and ‘test and endoscopy’ strategies are not suitable for the management of patients with uninvestigated dyspepsia 11. Nonetheless, because dyspepsia is so prevalent in the general population, it is impossible to recommend prompt endoscopy for all patients with dyspepsia; therefore, efforts have been made to minimise unnecessary endoscopy by restricting its use to those above a certain age, generally 45–55 years old, or to those who present with alarm features.…”

Dyspepsia is strongly associated with major depression and generalised anxiety disorder ‐ a community study

“…Our previous endoscopy study in referred patients with dyspepsia found organicity in less than 10% of patients. 34 The Kalixanda study found no organicity in 77% of uninvestigated dyspepsia cases, 15 while a metaanalysis found positive endoscopy in 20% of dyspeptics, only 6% in Rome-defined dyspeptics. 35 Second, we did a brief telephone survey instead of a detailed face-to-face one.…”

Helicobacter pylori“test-and-treat” strategy is not suitable for the management of patients with uninvestigated dyspepsia in Shanghai

“…Sung et al prospectively conducted a controlled trial including 2627 uninvestigated dyspepsia patients to evaluate the safety of the ''testand-treat'' strategy. The study showed that 3 cases of gastric cancer and 1 case of esophageal cancer were found in 1017 patients under 45 years of age with no alarm symptoms, and all 3 patients with gastric cancer were found to have H. pylori infection [22]. The results cast doubt on the safety of the ''test-andtreat'' strategy.…”