Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2015; 21(2): 637-643
Published online Jan 14, 2015. doi: 10.3748/wjg.v21.i2.637
Performance of American Society for Gastrointestinal Endoscopy guidelines for dyspepsia in Saudi population: Prospective observational study
Nahla A Azzam, Majid A Almadi, Hessah Hamad Alamar, Lamis Atyah Almalki, Rehab Nawaf Alrashedi, Rawabi Saleh Alghamdi, Waleed Al-hamoudi
Nahla A Azzam, Majid A Almadi, Hessah Hamad Alamar, Lamis Atyah Almalki, Rehab Nawaf Alrashedi, Rawabi Saleh Alghamdi, Waleed Al-hamoudi, Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh 11461, Saudi Arabia
Majid A Almadi, Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal H3A0G4, Canada
Waleed Al-hamoudi, Division of liver transplant, King Faisal Specialist Hospital and Research Center, Riyadh 11461, Saudi Arabia
Author contributions: Azzam NA and Al-hamoudi W carried our majority of study; Almadi MA carried out the analysis and involved in editing the manuscript; Almalki LA, Alrashedi RN, Alghamdi RS and Alamar HH were involved in the study design and editing the manuscript.
Supported by The Deanship of Scientific Research at King Saud University for funding this Research group number ​RGP​​-VPP-279.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Waleed Al-hamoudi, Division of Gastroenterology, King Khalid University Hospital, King Saud University, PO Box 2925(59), Riyadh 11461, Saudi Arabia. walhamoudi@gmail.com
Telephone: +966-11-4679167 Fax: +966-11-4671217
Received: May 12, 2014
Peer-review started: May 13, 2014
First decision: June 10, 2014
Revised: July 7, 2014
Accepted: August 28, 2014
Article in press: August 28, 2014
Published online: January 14, 2015
Processing time: 250 Days and 19.6 Hours
Abstract

AIM: To evaluate adherence of primary care physicians (PCPs) to international guidelines when referring patients for upper-gastrointestinal endoscopy (UGE), evaluate the importance of alarm symptoms and the performance of the American Society for Gastrointestinal Endoscopy (ASGE) guidelines in a Saudi population.

METHODS: A prospective, observational cross-sectional study on dyspeptic patients undergoing UGE who were referred by PCPs over a 4 mo period. Referrals were classified as appropriate or inappropriate according to adherence to ASGE guidelines.

RESULTS: Total of 221 dyspeptic patients was enrolled; 161 patients met our inclusion criteria. Mean age was 40.3 years (SD ± 18.1). Females comprised 70.1%. Alarm symptoms included low hemoglobin level (39%), weight loss (18%), vomiting (16%), loss of appetite (16%), difficulty swallowing (3%), and gastrointestinal bleeding (3%). Abnormal endoscopy findings included gastritis (52%), duodenitis (10%), hiatus hernia (7.8%), features suggestive of celiac disease (6.5%), ulcers (3.9%), malignancy (2.6%) and gastroesophageal reflux disease (GERD: 17%). Among patients who underwent UGE, 63% met ASGE guidelines, and 50% had abnormal endoscopic findings. Endoscopy was not indicated in remaining 37% of patients. Among the latter group, endoscopy was normal in 54% of patients. There was no difference in proportion of abnormal endoscopic findings between two groups (P = 0.639).

CONCLUSION: Dyspeptic patients had a low prevalence of important endoscopic lesions, and none of the alarm symptoms could significantly predict abnormal endoscopic findings.

Keywords: Dyspepsia; Primary care physician; American Society for Gastrointestinal Endoscopy guideline; Upper gastrointestinal endoscopy; Saudi population

Core tip: A prospective study looking at the practice of primary care physicians in referring dyspeptic patients for endoscopy in Saudi Arabia, such study is the first prospective study to evaluate such practice in high Helicobacter pylori endemic area and the adherence of general practitioners to the international guidelines for a common gastroenterology disorder, and this will shed light on the approach for such disease.