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Multicenter Study
. 2025 Jul;57(7):1481-1486.
doi: 10.1016/j.dld.2025.03.026. Epub 2025 Apr 11.

Alarm symptoms and the risk of upper gastrointestinal cancer in patients below the age of 60

F Theunissen  1 , P C J Ter Borg  2 , R J T Ouwendijk  2 , M J Bruno  3 , P D Siersema  3 ; Trans.IT foundation study group
Collaborators, Affiliations
Free article
Multicenter Study

Alarm symptoms and the risk of upper gastrointestinal cancer in patients below the age of 60

F Theunissen et al. Dig Liver Dis. 2025 Jul.
Free article

Abstract

Background and study aim: Current guidelines recommend against routine Upper gastrointestinal (GI) endoscopy in patients under 60 with alarm symptoms due to the perceived low risk of malignancy. This study aimed to evaluate the diagnostic yield of upper GI endoscopy in patients under 60 years presenting with alarm symptoms and to compare these findings with a cohort of patients with dyspepsia without alarm symptoms.

Methods: We analyzed data from a multicenter endoscopy database. We included and compared all upper GI endoscopy patients under 60 with alarm symptoms to patients with only dyspepsia under 60. The primary outcomes were major endoscopic findings, including GI cancer, ulcers, strictures, and severe esophagitis. Logistic regression assessed the association between alarm symptoms and outcomes.

Results: A total of 7209 patients with alarm symptoms and 13,978 with dyspepsia were included. The prevalence of major endoscopic findings was significantly higher in the alarm symptoms cohort (9.5 % vs. 3.7 %, P < 0.001), with a higher incidence of GI cancer (1.7 % vs. 0.3 %, P < 0.001). Dysphagia, unintentional weight loss, and persistent vomiting were significantly associated with cancer, while dysphagia and gastrointestinal bleeding were significantly associated with major endoscopic findings.

Conclusions: Our findings question current guideline recommendations and show a significantly increased yield of major endoscopic findings, including malignancy, in patients under 60 with alarm symptoms.

Keywords: Dyspepsia; Endoscopy; Gastric cancer.

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Conflict of interest statement

Declaration of competing interest F. Theunissen: no conflicting interests P.C.J. ter Borg: no conflicting interests R.J. Ouwendijk: Research grants from Janssen Netherlands, Norgine and the Coolsingel Foundation. M.J. Bruno: Boston Scientific; Consultant, support for industry and investigator-initiated studies; Cook Medical; Consultant, support for industry and investigator-initiated studies; Pentax Medical; support for investigator-initiated studies; Mylan; support for investigator-initiated studies; ChiRoStim; support for investigator-initiated studies P.D. Siersema: Non-restricted research grants from Norgine, Pentax, FujiFilm, Microtech, Sanofi and Magentiq Eye; Advisory Board of Sanofi.

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