Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2024; 30(26): 3210-3220
Published online Jul 14, 2024. doi: 10.3748/wjg.v30.i26.3210
Yield of alarm features in predicting significant endoscopic findings among hospitalized patients with dyspepsia
Lama Ibrahim, Maamoun Basheer, Tawfik Khoury, Wisam Sbeit
Lama Ibrahim, Department of Internal Medicine, Galilee Medical Center, Nahariya 22001, Israel
Maamoun Basheer, Tawfik Khoury, Wisam Sbeit, Department of Gastroenterology, Galilee Medical Center, Nahariya 22001, Israel
Maamoun Basheer, Tawfik Khoury, Wisam Sbeit, Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
Author contributions: Khoury T and Sbeit W contributed to the study concept and design, and reviewed the manuscript for critical intellectual content; Ibrahim L contributed to the data collection; Ibrahim L, Basheer M, and Sbeit W wrote the first draft of the manuscript; All authors approved the final version of the manuscript to be published.
Institutional review board statement: The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki and was approved by the human research committee of each institution (Approval No. 0189-21-NHR).
Informed consent statement: Written informed consent was waived by the local ethical committees due to the retrospective non-interventional nature of the study.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: The data are available with the corresponding author at the Gastroenterology department at Galilee Medical Center, and will be available upon reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Maamoun Basheer, MD, Research Scientist, Department of Gastroenterology, Galilee Medical Center, 89 Nahariya-Cabri Road, Nahariya 22001, Israel. maamon.basheer@mail.huji.ac.il
Received: January 13, 2024
Revised: April 29, 2024
Accepted: May 16, 2024
Published online: July 14, 2024
Processing time: 178 Days and 3.5 Hours
Abstract
BACKGROUND

Dyspepsia is a very prevalent upper gastrointestinal tract symptoms complex. Some of these symptoms might arise from serious underlying diseases, so the promotion of evidence-based guidelines could potentially better align evaluation and treatment.

AIM

To determine the value of alarm features as a predictive factor for significant endoscopic findings (SEFs) among hospitalized patients presenting with dyspepsia.

METHODS

We conducted a retrospective case-control study including information about 6208 endoscopic procedures performed for hospitalized patients. Patients were divided into two groups, with and without SEFs, and compared to elucidate the ability of the different alarm features to predict SEFs.

RESULTS

During the study, 605 patients fulfilled the inclusion criteria. When the demographics and clinical characteristics of the two groups were compared, tachycardia (P < 0.05), normocytic anemia, (P < 0.05), leukocytosis (P < 0.05), and hypoalbuminemia (P < 0.05) documented on admission prior to endoscopy were strong predictors of SEFs. Among the alarm features, upper gastrointestinal bleeding, persistent vomiting, odynophagia [odds ratio (OR) = 3.81, P < 0.05; OR = 1.75, P = 0.03; and OR = 7.81, P = 0.07, respectively] were associated with SEFs. Unexplained weight loss was strongly associated with malignancy as an endoscopic finding (OR = 2.05; P < 0.05). In addition, long-term use of anti-aggregate medications other than aspirin (P < 0.05) was correlated to SEFs.

CONCLUSION

Novel predictors of SEFs were elucidated in this study. These parameters could be used as an adjunctive in decision making regarding performing upper endoscopy in hospitalized patients with dyspepsia.

Keywords: Dyspepsia; Endoscopy; Weight loss; Anti-aggregate medications; Persistent vomiting; Odynophagia

Core Tip: Dyspepsia is a common symptom complex necessitating medical consultation. Alarm features usually guide the necessity of performing upper endoscopy in the outpatient settings. Upper endoscopy and data regarding alarm features in hospitalized patients with dyspepsia are lacking. We found that tachycardia, persistent vomiting, normocytic anemia, upper gastrointestinal bleeding, leukocytosis, and hypoalbuminemia were strongly associated with significant endoscopic findings. Unexplained weight loss and abnormal computed tomography findings were strongly associated with malignancy. This is the first study exploring alarm features in hospitalized patients with dyspepsia. Our findings might guide physicians in prioritizing hospitalized patients for upper endoscopy performance.