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©The Author(s) 2024.
World J Gastroenterol. Jul 14, 2024; 30(26): 3210-3220
Published online Jul 14, 2024. doi: 10.3748/wjg.v30.i26.3210
Published online Jul 14, 2024. doi: 10.3748/wjg.v30.i26.3210
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 |
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) |
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 |
Table 4 Correlation between regular medication use during dyspeptic symptom period, n (%)
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 |
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) |
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 |
- Citation: Ibrahim L, Basheer M, Khoury T, Sbeit W. Yield of alarm features in predicting significant endoscopic findings among hospitalized patients with dyspepsia. World J Gastroenterol 2024; 30(26): 3210-3220
- URL: https://www.wjgnet.com/1007-9327/full/v30/i26/3210.htm
- DOI: https://dx.doi.org/10.3748/wjg.v30.i26.3210