Age is a predictor of significant endoscopic findings in dyspepsia patients in South Africa

Abstract

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 dyspepsia.

Methods: A retrospective chart review of 1 000 consecutive endoscopies done at Madadeni Provincial Hospital, KwaZuluNatal, 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 recorded.

Results: 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 = 0.230).

Conclusion: 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.