Diagnostic value of endoscopy in adult patients with dyspepsia

Abstract

Introduction: Dyspepsia is a common gastrointestinal (GI) complaint with predominant underlying normal findings or trivial lesions and may be a symptom of serious morbidity.

Aim: To assess the significance of endoscopic findings in the case of uninvestigated dyspepsia in adults.

Material and methods: This is a single-centre cross-sectional descriptive study of 372 patients (198 females, 174 males) who presented with dyspepsia and underwent endoscopic examination. Demographic, clinical complaints with alarm features, drug use, and endoscopic findings were collected and analysed. Gastric biopsy was performed to detect Helicobacter pylori (H. pylori) infection. Findings of erosions, ulcers, and neoplasms were regarded as significant lesions.

Results: Mean age of patients was 35.7 ±13.5 years. The main presenting symptom of dyspepsia was epigastric pain (61.6%). The endoscopic findings were gastroduodenitis (GD) (47.6%), esophagitis (15.1%), peptic ulcers (7.3%), cancer of the stomach (0.8%), and gastric polyps (0.5%). Non-significant and normal findings represented 70.2% (261/372, p < 0.001). Age group ≥ 50 years manifested significant lesions in 45.7% (32/70), and age group < 50 years 26.2% (79/302). Weight loss, anaemia, vomiting, and nonsteroidal anti-inflammatory drugs (NSAIDs) were associated with significant lesions in 85.7%, 84.2%, 32.7%, and 58.3%, respectively. H. pylori prevalence in patients without organic lesions was 47.7%.

Conclusions: In two thirds of patients presented with dyspepsia, endoscopy revealed minor or normal findings. Age group ≥ 50 years, alarm features, and use of NSAIDs were predictive of significant endoscopic findings. Strict clinical criteria should be adopted before referring patients with dyspepsia to endoscopy.

Keywords: Helicobacter pylori; dyspepsia; endoscopy; epigastric pain.

Figure 1

Frequency of esophagitis subtypes (n = 56)