The yield and the predictors of esophageal pathology when upper endoscopy is used for the initial evaluation of dysphagia

Varadarajulu, Shyam; Eloubeidi, Mohamad A.; Patel, Rig S.; Mulcahy, Hugh; Barkun, Alan N.; Jowell, Paul S.; Libby, Eric; Schutz, Stephen M.; Nickl, Nicholas; Cotton, Peter B.

doi:10.1016/s0016-5107(05)00297-x

Cited by 65 publications

(60 citation statements)

References 19 publications

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“…We also made a diagnosis that could cause abdominal pain in 47 patients with esophagogastroduodenoscopy and 25 patients with colonoscopy. We were able to diagnose more patients with esophagogastroduodenoscopy than with colonoscopy, similar to other studies (Van Mook et al, 2001;Varadarajulu et al, 2005;Stray and Weberg, 2006;Harris et al, 2007;Thakkar et al, 2007). The patients were treated in accordance with the diagnoses.…”

Section: Middle Black Sea Journal Of Health Science 10supporting

confidence: 80%

“…Upper gastrointestinal endoscopy is recommended for patients with odynophagia, chest pain, vomiting, weight loss, epigastric burning symptoms and iron deficiency anemia in addition to abdominal pain, and colonoscopy is recommended for patients with anemia, hematochezia, chronic diarrhea, weight loss, and change in intestinal habits in addition to abdominal pain (Van Mook et al, 2001;Varadarajulu et al, 2005;Stray and Weberg, 2006;Harris et al, 2007). Major pathology was found in more than 50% of the patients evaluated with upper GIS endoscopy due to symptoms of abdominal pain, odynophagia, weight loss, and vomiting by Varadarajulu et al (2005) and the authors recommended upper GIS endoscopy in patients with odynophagia, burning, and weight loss, especially when the patient is an elderly male. The most common etiology in children presenting with abdominal pain was reflux esophagitis with upper GIS endoscopy in the study conducted by Thakkar et al (2007).…”

Section: Middle Black Sea Journal Of Health Science 10mentioning

confidence: 99%

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Same Day Upper and Lower Endoscopy Results in Patients Presenting with Nonspecific Abdominal Pain

Allahverdi

Sulu

2015

Mid. Black Sea J of Health Sci.

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Objective: The aim of this study was to evaluate the upper gastrointestinal endoscopy and colonoscopy results in patients who presented with abdominal pain and received a diagnosis of nonspecific abdominal pain following the examination and tests. Methods: We included a total of 52 patients who presented at the emergency service between 01.01.2011 and 01.01.2012 with symptoms of abdominal pain and received a diagnosis of nonspecific abdominal pain following normal examination, routine blood and urine tests and ultrasound analysis. All patients underwent upper gastrointestinal endoscopy and colonoscopy on the same day. The results were evaluated and diagnoses made according to the endoscopy and pathology findings. Results: There were 23 (44.2%) males and 29 (55.8%) females. The mean age was 54.5 ± 15.3 (23-86) years. A pathology was present on upper endoscopy in 47 (90.4%) patients and lower endoscopy in 27 (51.9%) patients. Comparison of the pathology rates for upper endoscopy and colonoscopy showed a significantly higher rate for upper endoscopy. The most common findings were chronic gastritis with upper endoscopy 13 males (25%) and 17 (32.7%) females, hemorrhoids with colonoscopy 10 males (19.2%) and 12 (23.1%) females. A pathology was present on both examinations in 25 (48%) patients. Cancer was found in 7 (13.5%) patients (6 gastric, 1 colon cancer). Helicobacter pylori was (+) in 53.8% of the cases. Conclusion: Same day upper and lower endoscopy in patients with nonspecific abdominal pain provided important results. However, we feel upper endoscopy should have priority when it is not possible to perform both investigations.

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Section: Middle Black Sea Journal Of Health Science 10supporting

confidence: 80%

Section: Middle Black Sea Journal Of Health Science 10mentioning

confidence: 99%

Same Day Upper and Lower Endoscopy Results in Patients Presenting with Nonspecific Abdominal Pain

Allahverdi

Sulu

2015

Mid. Black Sea J of Health Sci.

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“…5 However, much of the information available to guide decision making is based on data from secondary care. [5][6][7] These studies demonstrate a wide variation in the sensitivity and specificity of alarm symptoms for upper gastrointestinal malignancies. More recent studies from primary care demonstrate that an approach focused on single symptoms alone such as dysphagia is likely to miss 40% of current gastro-oesophageal cancers.…”

Section: Introductionmentioning

confidence: 78%

Identifying patients with suspected gastro-oesophageal cancer in primary care: derivation and validation of an algorithm

Hippisley‐Cox

Coupland

2011

Br J Gen Pract

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BackgroundGastro-oesphageal is one of the most common cancers worldwide. Evidence suggested that increased awareness of symptoms and earlier diagnosis could help improve treatment options and improve survival. AimTo derive and validate an algorithm to estimate the absolute risk of having gastro-oesophageal cancer in patients in primary care with and without symptoms. Design and settingCohort study of 375 UK QResearch ® general practices for development, and 189 for validation. MethodIncluded patients were aged 30-84 years, free at baseline of a diagnosis of gastro-oesophageal cancer, and without dysphagia, haematemesis, abdominal pain, appetite loss, or weight loss recorded in previous 12 months. The primary outcome was incident diagnosis of gastrooesophageal cancer recorded in the next 2 years. Risk factors examined were age, body mass index, alcohol status, smoking status, deprivation, family history of gastrointestinal cancer, dysphagia, previous diagnosis of cancer apart from gastrooesophageal cancer, haematemesis, abdominal pain, appetite loss, weight loss, tiredness, and anaemia. Cox proportional hazards models were used to develop risk equations. Measures of calibration and discrimination assessed performance in the validation cohort. ResultsThere were 2527 incident cases of gastrooesophageal cancer from 4.1 million person-years in the derivation cohort. Independent predictors were age, smoking, dysphagia, haematemesis, abdominal pain, appetite loss, weight loss, and anaemia. On validation, the algorithms explained 71% of the variation in females and 73% in males. The receiver operating curve statistics were 0.89 (females) and 0.92 (males). The D statistic was 3.2 (females) and 3.3 (males). The 10% of patients with the highest predicted risks included 77% of all gastro-oesophageal cancers diagnosed over the next 2 years. ConclusionThe algorithm has good performance and could potentially be used to help identify those at highest risk of gastro-oesophageal cancer, to facilitate early referral and investigation.

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“…Patients with strictures, who tend to have a chronic history of heartburn and GERD-like symptoms, rarely experience weigh loss given maintenance of appetite However, if the solid food dysphagia is distinctively progressive, peptic esophageal stricture and carcinoma are more likely. Patients with carcinoma are ususally men older than 40 years who present with rapidly progressive dysphagia that is accompanied by alarm symptoms such as severe anorexia, weight loss, and persistent odynophagia [26]. This presentation necessitates further investigation with upper endoscopy and biopsy.…”

Section: Dysphagiamentioning

confidence: 99%

“…Some experts use EGD as the initial test, whereas others advocate use of barium radiograph with ingestion of solids first. Although the choice of initial test should be based on provider expertise and preference [3], most complaints of dysphagia will warrant upper endoscopy given the diagnostic versatility of an EGD [26]. For example, if barium evaluation depicts an obstructive lesion, the next step would be endoscopy with biopsy for confirmation.…”

Section: Dysphagiamentioning

confidence: 99%

Medical evaluation for patients with symptomatic esophageal disease

Kumar

Shah

2015

Techniques in Gastrointestinal Endoscopy

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The yield and the predictors of esophageal pathology when upper endoscopy is used for the initial evaluation of dysphagia

Cited by 65 publications

References 19 publications

Same Day Upper and Lower Endoscopy Results in Patients Presenting with Nonspecific Abdominal Pain

Same Day Upper and Lower Endoscopy Results in Patients Presenting with Nonspecific Abdominal Pain

Identifying patients with suspected gastro-oesophageal cancer in primary care: derivation and validation of an algorithm

Medical evaluation for patients with symptomatic esophageal disease

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