Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb 26;13(2):111-118.
doi: 10.1136/flgastro-2020-101759. eCollection 2022.

Risk stratifying gastric ulcers: development and validation of a scoring system

William M Brindle  1 , Rebecca K Grant  1 , Marianne Smith  1 , Meghan Suddaby  1 , Angus Wallace  1 , Sarah-Louise Gillespie  1 , Nicholas I Church  1 , Colin L Noble  2 , Ian D Penman  1 , John N Plevris  1 , Alexander R Robertson  2 , Eleanor F Watson  2 , Christian P Selinger  3 , Rahul Kalla  1 , Gail S M Masterton  1 ; EGAR (Edinburgh GI Audit and Research) Collaborative
Affiliations

Risk stratifying gastric ulcers: development and validation of a scoring system

William M Brindle et al. Frontline Gastroenterol. .

Abstract

Objective: Debate is ongoing regarding the need for universal endoscopic follow-up to ensure gastric ulcer healing. We aimed to assess the value of follow-up oesophago-gastro-duodenoscopies (OGDs) for gastric ulcer healing and stratify patients according to risk of malignancy by developing a risk score.

Design/method: All patients in National Health Service (NHS) Lothian with an index OGD and a diagnosis of gastric ulcer between 1 January 2014 and 31 December 2018 were identified. Data were analysed with logistic regression to identify factors significantly associated with a diagnosis of cancer; a risk score was derived and externally validated.

Results: 778 patients were identified and 60.3% (469/778) of patients had a follow-up OGD. 8.6% (66/778) of patients were diagnosed with cancer. No cases of cancer were found on follow-up OGD of a benign appearing ulcer with negative biopsies. Macroscopic suspicion of malignancy was present at index OGD in 100% (3/3) of those diagnosed with cancer on subsequent OGDs. Older age (p=0.014), increased ulcer size (p<0.001) and non-antral location (p=0.030) were significantly associated with malignancy. A risk score (area under the curve (AUC) 0.868, p<0.001, minimum score=0, maximum score=6) was derived from these variables. 78.0% of patients with malignant ulcers scored ≥3, only 15.8% with benign ulcers scored ≥3 (negative predictive value (NPV) 97.4%). External validation yielded an AUC of 0.862 (p<0.001) and NPV of 98.6%; 84.0% of those with malignant ulcers scored ≥3.

Conclusion: Ulcers with a combination of macroscopically benign appearances, at least six negative biopsies and a low risk score do not necessarily need endoscopic follow-up.

Keywords: gastric and duodenal ulcers; gastrointesinal endoscopy; gastrointestinal cancer.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
ROC curve analysis of novel risk score in derivation and validation cohorts. AUC, area under the curve; ROC, receiver operator characteristic.
Figure 2
Figure 2
Distribution of scoring.
Figure 3
Figure 3
Proposed algorithm for application of gastric ulcer risk score. GI, gastrointestinal; OGD, oesophago-gastro-duodenoscopy.
See this image and copyright information in PMC

References

    1. Allum WH, Blazeby JM, Griffin SM, et al. . Guidelines for the management of oesophageal and gastric cancer. Gut 2011;60:1449–72. 10.1136/gut.2010.228254 - DOI - PubMed
    1. Beg S, Ragunath K, Wyman A, et al. . Quality Standards in upper gastrointestinal endoscopy: a position statement of the British Society of gastroenterology (BSG) and association of upper gastrointestinal surgeons of great britain and ireland (AUGIS). Gut 2017;66:1886–99. 10.1136/gutjnl-2017-314109 - DOI - PMC - PubMed
    1. Sverdén E, Agréus L, Dunn JM, et al. . Peptic ulcer disease. BMJ 2019;16:l5495. 10.1136/bmj.l5495 - DOI - PubMed
    1. NICE Pathway . Managing peptic ulcer disease in adults; 2020.
    1. Public Health Scotland . Stomach cancer statistics, 2020. Available: https://www.isdscotland.org/Health-Topics/Cancer/Cancer-Statistics/Stomach/ [Accessed 11 Aug 2020].

LinkOut - more resources