Yield of alarm features in predicting significant endoscopic findings among hospitalized patients with dyspepsia

Table 1 Basic demographics of the study population

Features	n of 605	%
Age, mean ± SD (58.2 ± 19), median = 60
< 60 years	294	48.6
≥ 60 years	311	51.4
Sex
Female	297	49.2
Male	307	50.8
Duration of symptoms
< 30 days	330	62.6
30-59 days	75	13.2
60-89 days	11	7.3
≥ 90 days	14	9.3
Control without alarm features	92	15.2
Patients with alarm features	513	84.8
Alarm features
Upper GI bleeding	144	23.8
Unexplained weight loss	137	22.6
Persistent vomiting	124	20.5
Iron deficiency anemia	50	8.3
Dysphagia	37	6.1
Odynophagia	5	0.8
Epigastric mass or lymphadenopathy	1	0.2
Endoscopic finding
Patients without endoscopic finding	431	71.2
Patients with any endoscopic finding	174	28.8
Peptic ulcer disease	92	15.2
Erosive esophagitis class B or higher	34	5.6
Malignancy	42	6.9
Stricture	1	0.2
Finding requiring specific therapy	15	2.5
Medications
PPIs	173	29
Statins	191	32.3
Aspirin	111	18.8
Anticoagulant	39	6.6
Anti-aggregate	30	5.1
NSAIDs	23	3.9

GI: Gastrointestinal; NSAIDs: Non-steroidal anti-inflammatory drugs; PPI: Proton pump inhibitors; SD: Standard deviation.

Table 2 Patients’ clinical and demographics characteristics at presentation in both groups with and without significant endoscopic findings, n (%)

Patients’ clinical characteristics	Total, n = 605	SEFs, n = 174	No SEFs, n = 431	P value
Sex				0.081
Female	297 (49.2)	94 (54)	203 (47.2)
Male	307 (50.8)	80 (46)	227 (52.8)
Duration of symptoms				0.012
< 30 days	330 (62.2)	106 (70.2)	224 (59.6)
30-59 days	75 (14.2)	20 (13.2)	55 (14.6)
60-89 days	39 (7.4)	11 (7.3)	28 (7.4)
≥ 90 days	83 (15.7)	14 (9.3)	69 (18.4)
Pulse				0.0012
Bradycardia	51 (8.5)	10 (5.8)	41 (9.5)
Normal pulse	524 (86.9)	146 (84.4)	378 (87.9)
Tachycardia	28 (4.6)	17 (9.8)	11 (2.6)
Blood pressure				0.082
Hypotension	61 (10.1)	24 (13.9)	37 (8.6)
Normal BP	417 (69.3)	116 (67.1)	301 (70.2)
Hypertension	124 (20.6)	33 (19.1)	91 (21.2)

¹Pearson χ² test.

²Mann-Whitney test.

BP: Blood pressure; SEFs: Significant endoscopic findings.

Table 3 Patients’ blood test, n (%)

CBC	Total (%), n = 605	SEFs, n = 174	No SEFs, n = 431	P value
Normal CBC	234 (38.7)	39 (22.4)	195 (45.2)	< 0.0011
Abnormal CBC	371 (61.3)	135 (77.6)	236 (54.8)
Normocytic anemia	194 (32.1)	83 (47.7)	111 (25.8)	< 0.0011
Microcytic anemia	87 (14.4)	28 (16.1)	59 (13.7)	0.521
Macrocytic anemia	3 (0.5)	1 (0.6)	2 (0.5)	1.03
Leukocytosis	134 (22.1)	52 (29.9)	82 (19)	0.0051
Leukopenia	8 (1.3)	2 (1.1)	6 (1.4)	1.03
Thrombocytosis	18 (3.0)	7 (4.0)	11 (2.6)	0.4271
Thrombocytopenia	14 (2.3)	6 (3.4)	8 (1.9)	0.243
CRP
CRP normal, < 5	289 (47.9)	83 (47.7)	206 (48.0)	1.001
CRP abnormal	314 (52.1)	91 (52.3)	223 (52.0)
Albumin
Hypoalbuminemia	102 (17.2)	47 (28.0)	55(12.9)	< 0.0012
Normal albumin	489 (82.3)	118 (70.2)	371 (87.1)
Hyperalbuminemia	3 (0.5)	3 (1.8)	0 (0)
Liver function test
Normal	554 (91.7)	157 (90.2)	397 (92.3)	0.4161
Hepatocellular enzymes elevated	39 (6.5)	13 (7.5)	26 (6.0)	0.581
Cholestatic enzymes elevated	22 (3.6)	9 (5.2)	13 (3.0)	0.2311

¹Pearson χ² test.

²Mann-Whitney test.

³Fisher exact test.

CBC: Complete blood count; CRP: C reactive protein; SEFs: Significant endoscopic findings.

Table 4 Correlation between regular medication use during dyspeptic symptom period, n (%)

Drug	Total (%), n = 605	SEFs, n = 174	No SEFs, n = 431	P value
PPI	173 (29)	48 (28.2)	125 (29.6)	0.771
NSAIDs	23 (3.9)	9 (5.3)	14 (3.3)	0.351
Aspirin	111 (18.8)	27 (15.9)	84 (19.9)	0.291
Statin	191 (32.3)	54 (31.8)	137 (32.4)	0.921
Anticoagulant	39 (6.6)	10 (5.9)	29(6.9)	0.721
Anti-aggregate	30 (5.1)	13 (7.6)	17 (4)	0.051

¹Pearson χ² test.

NSAIDs: Non-steroidal anti-inflammatory drugs; PPI: Proton pump inhibitors; SEFs: Significant endoscopic findings.

Table 5 Association of alarm features with significant endoscopic findings, n (%)

Alarm features	Total (%), n = 605	SEFs, n = 174	No SEFs, n = 431	P value
Unexplained weight loss	137 (22.6)	35 (20.1)	102 (23.7)	0.3911
Dysphagia	37 (6.1)	13 (7.5)	24 (5.6)	0.4531
Persistent vomiting	124 (20.5)	40 (23.0)	84 (19.5)	0.3731
Odynophagia	5 (0.8)	2 (1.1)	3 (0.7)	0.6293
Upper GI bleeding	145 (24)	67 (38.5)	78 (18.1)	< 0.0011
IDA	50 (8.3)	12 (6.9)	38 (8.8)	0.5161
Epigastric mass or lymphadenopathy	1 (0.2)	0	1 (0.2)	1.0003

¹Pearson χ² test.

³Fisher’s exact test.

GI: Gastrointestinal; IDA: Iron deficiency anemia.

Table 6 Correlation between radiologic findings during hospitalization and endoscopic findings, n (%)

Imaging modality	Total (%), n = 605	SEFs, n = 174	No SEFs, n = 431	OR	95%CI	P value
Imaging modality not performed	188 (31.2)	64 (37)	124 (28.8)	1.45	0.99-2.1	0.051
Imaging modality performed	415 (68.8)	109 (63)	306 (71.2)
CT	345 (57)	n = 100	n = 245
Normal abdominal CT	214(62)	31 (31)	183 (74.7)	6.57	3.94-11	< 0.001
CT shows suspected PUD	5 (0.8)	2 (2.0)	3 (1.2)	1.65	0.27-100	0.59
CT shows suspected SOL	35 (10.1)	26 (26.0)	9 (3.7)	9.21	4.13-20.54	< 0.001
CT shows bowel wall thickening	60 (17.4)	25 (25.0)	35 (14.3)	2	1.12-3.56	0.02
CT shows stricture	5 (0.8)	2 (2.0)	3 (1.2)	1.65	0.27-10	0.59
CT shows metastatic disease	12 (2.0)	9 (9.0)	3 (1.2)	8	2.11-30.13	0.002
CT shows distended stomach	9 (1.5)	5 (5.6)	4 (1.6)	3.17	0.83-12.1	0.09
CT shows lymphadenopathy	8 (1.3)	3(3.0)	5 (2.0)	1.48	0.35-6.33	0.59
US	113 (18.7)	n = 19	n = 94
Normal abdominal US	110 (97.3)	19 (100)	91 (96.8)	0		1
US shows cholecystitis	3 (2.7)	0 (0.0)	3 (3.2)

CI: Confidence interval (calculated on the basis of univariate logistic regression); CT: Computerized tomography; OR: Odds ratio; SEFs: Significant endoscopic findings; SOL: Space-occupying lesion; US: Ultrasound.

Table 7 Five models presenting the correlation between alarm features and other variables found significant in our univariate analysis and significant endoscopic findings

Model	Variables	P value	OR	95%CI for OR
1	Dependent variable: Significant endoscopic finding
	Persistent vomiting	0.09	1.59	0.93	2.73
	Odynophagia	0.08	12.65	0.72	222.11
	UGIB	< 0.001	3.48	2.07	5.86
	Normocytic anemia	0.003	2.06	1.28	3.29
	Leukocytosis	0.02	1.83	1.11	3.04
	Low albumin	0.05	1.78	1.01	3.15
	Duration of symptoms	0.04	0.99	0.99	1.00
	Abnormal CT2	< 0.001	7.83	4.21	14.54
2	Dependent variable: Significant endoscopic finding (duration of symptoms not included)
	Persistent vomiting	0.03	1.75	1.05	2.91
	Odynophagia	0.07	7.81	0.85	72.07
	UGIB	< 0.001	3.22	1.97	5.27
	Normocytic anemia	< 0.001	2.36	1.51	3.69
	Leukocytosis	0.01	1.83	1.13	2.98
	Hypoalbuminemia	0.04	1.77	1.04	3.01
	Abnormal CT2	< 0.001	8.64	4.82	15.49
	Tachycardia	0.01	3.11	1.26	7.69
3	Dependent variable: Peptic ulcer disease
	Unexplained weight loss	0.009	0.31	0.13	0.75
	Persistent vomiting	0.04	1.92	1.05	3.75
	UGIB	< 0.001	3.81	2.22	6.52
	Normocytic anemia	< 0.001	3.12	1.77	5.48
	Leukocytosis	0.03	1.92	1.06	3.48
	Abnormal CT2	0.04	2.29	1.03	5.10
	tachycardia	0.03	2.85	1.14	7.17
4	Dependent variable: Erosive esophagitis class B or higher
	Odynophagia	0.004	21.03	2.69	164.31
	Anti-aggregate medications	0.01	3.94	1.37	11.33
	Leukocytosis	0.003	2.99	1.45	6.17
5	Dependent variable: Malignancy as an endoscopic finding
	Unexplained weight loss	0.07	2.05	0.95	4.41
	Abnormal CT2	< 0.001	39.68	11.81	133.33

¹We suggest that upper limit of 95% confidence interval for odds ratio of odynophagia is high unproportionate due to the small number of patients with odynophagia in comparison to the sample size. The rest of the models’ main dependent factor is each significant endoscopic finding with the above-mentioned variables.

²Abnormal contrast tomography is a variable we created which consists of contrast tomography showing suspected space-occupying lesion, lymphadenopathy or a metastatic disease.

The first model solely includes duration of symptoms as one of the variables. CI: Confidence interval; CT: Computed tomography; OR: Odds ratio; UGIB: Upper gastrointestinal bleeding.