Abstract

CHEDDIE, S; MANNEH, CG; OWCZAREK, BM  and  MOODLEY, Y. Age is a predictor of significant endoscopic findings in dyspepsia patients in South Africa. S. Afr. j. surg. [online]. 2020, vol.58, n.1, pp.14-17. ISSN 2078-5151.  http://dx.doi.org/10.17159/2078-5151/2020/v58n1a2814.

BACKGROUND: Dyspepsia is the commonest indication for endoscopy. Current American guidelines recommend that all dyspepsia patients > 60 years undergo endoscopy to exclude significant pathology. The use of this age cut-off has never been analysed in South Africa. We aimed to compare different age cut-offs as predictors of significant endoscopic findings in patients with a primary diagnosis of dyspepsiaMETHODS: A retrospective chart review of 1 000 consecutive endoscopies done at Madadeni Provincial Hospital, KwaZulu-Natal, from 2014 to 2016 was performed. All patients with dyspepsia were identified and divided into age > 60 and < 60 cohorts and < 45 and > 45 cohorts. Demographic data, significant endoscopic findings (tumour, ulcer, and stricture) and non-significant findings (gastritis, hiatus hernia, candidiasis, and oesophagitis, normal) were recordedRESULTS: 584 patients (58.4%) presented with dyspepsia, with a median age of 49 years (interquartile range: 14-87). There were 142 males (24.4%) and 442 females (75.6%). 432 (74%) patients in the age < 60 cohort and 152 (26%) in the age > 60 cohort . There were 238 (41%) patients in the < 45 cohort and 346 (59%) patients in the > 45 cohort. In the age < 60 cohort, 6.7% of patients had significant findings, compared to 17.1% of patients in the age > 60 cohort (p-value < 0.001). In the age > 60 cohort, the positive predictive value (PPV) of endoscopy was 17%, negative predictive value (NPV) (93%) and odds ratio (OR) (2.87) p < 0.001. In the age < 45 cohort, 4.2% of patients had significant findings, compared to 13% of patients in the > 45 cohort (p-value < 0.001). In the age > 45 cohort, the PPV was 13%, NPV (96%) and OR (3.41) p < 0.001. There is no overall difference in significant endoscopic findings between the age > 45 and age > 60 groups (p = 0.230CONCLUSION: Age is a predictor of significant endoscopic findings in dyspepsia patients. Patients > 60 years with dyspepsia symptoms should undergo a routine endoscopy in the absence of alarm symptoms. The current ACG guidelines can be applied in the South African context

Keywords : dyspepsia; age cut-off; endoscopy; odds ratio.

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