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Published in: Digestive Diseases and Sciences 12/2012

01-12-2012 | Original Article

Clinically Significant Endoscopic Findings in a Multi-Ethnic Population With Uninvestigated Dyspepsia

Authors: Sanjiv Mahadeva, Khean-Lee Goh

Published in: Digestive Diseases and Sciences | Issue 12/2012

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Abstract

Introduction

The proportion of clinically significant endoscopic findings (CSEF) in dyspepsia affects the initial management of this condition. With the changing epidemiology of organic upper gastrointestinal diseases in Asia, current data on CSEF remains uncertain.

Methods

A cross-sectional study of consecutive adult patients attending an open access endoscopy list for the primary indication of dyspepsia was conducted. Independent epidemiological and clinical factors for CSEF were determined prospectively.

Results

Data for 1167/1208 (96.6 %) adults (mean age 49.7 ± 15.9 years, 42.4 % males, ethnic distribution: 30.5 % Malays, 36.9 % Chinese and 30.8 % Indians) were analysed between January 2007 and August 2008. Three-hundred and eight (26.4 %) patients were found to have CSEF, most often those with age ≥45 years (30.3 vs 19 %, P < 0.0001), male gender (34.1 vs 20.7 % female, P < 0.0001), lower education levels (i.e. primary or no education), smoking (36.7 vs 24.9 %, P = 0.003), H. pylori infection (40.6 vs 21.8 %, P < 0.0001), and duration of dyspepsia ≤5 months (32.8 vs 24.4 %, P = 0.006). Age ≥ 45 years (OR 1.82, 95 % CI = 1.38–2.48), male gender (OR 1.84, 95 % CI = 1.53–2.59), H. pylori infection (OR 2.36, 95 % CI = 1.83–3.26), and duration of dyspepsia ≤5 months (OR 1.44, 95 % CI = 1.13–2.03) were subsequently identified as independent risk factors for CSEF.

Conclusion

CSEF are found in 26.4 % of Asian adults with uninvestigated dyspepsia. Duration of symptoms <5 months, among other recognised factors, is predictive of CSEF.
Literature
1.
go back to reference Mahadeva S, Goh KL. Epidemiology of functional dyspepsia: a global perspective. World J Gastroenterol. 2006;12:2661–2666.PubMed Mahadeva S, Goh KL. Epidemiology of functional dyspepsia: a global perspective. World J Gastroenterol. 2006;12:2661–2666.PubMed
2.
go back to reference Ford AC, Forman D, Bailey AG, Axon AT, Moayyedi P. Initial poor quality of life and new onset of dyspepsia: results from a longitudinal 10-year follow-up study. Gut. 2007;56:321–327.PubMedCrossRef Ford AC, Forman D, Bailey AG, Axon AT, Moayyedi P. Initial poor quality of life and new onset of dyspepsia: results from a longitudinal 10-year follow-up study. Gut. 2007;56:321–327.PubMedCrossRef
3.
go back to reference Mahadeva S, Yadav H, Rampal S, Everett SM, Goh KL. Ethnic variation, epidemiological factors and quality of life impairment associated with dyspepsia in urban Malaysia. Aliment Pharmacol Ther. 2010;31:1141–1151.PubMed Mahadeva S, Yadav H, Rampal S, Everett SM, Goh KL. Ethnic variation, epidemiological factors and quality of life impairment associated with dyspepsia in urban Malaysia. Aliment Pharmacol Ther. 2010;31:1141–1151.PubMed
4.
go back to reference Thomson AB, Barkun AN, Armstrong D, et al. The prevalence of clinically significant endoscopic findings in primary care patients with uninvestigated dyspepsia: the Canadian Adult Dyspepsia Empiric Treatment-Prompt Endoscopy (CADET-PE) study. Aliment Pharmacol Ther. 2003;17:1481–1491.PubMedCrossRef Thomson AB, Barkun AN, Armstrong D, et al. The prevalence of clinically significant endoscopic findings in primary care patients with uninvestigated dyspepsia: the Canadian Adult Dyspepsia Empiric Treatment-Prompt Endoscopy (CADET-PE) study. Aliment Pharmacol Ther. 2003;17:1481–1491.PubMedCrossRef
5.
go back to reference Malfertheiner P, Megraud F, O’Morain C, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut. 2007;56:772–781.PubMedCrossRef Malfertheiner P, Megraud F, O’Morain C, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut. 2007;56:772–781.PubMedCrossRef
6.
go back to reference Talley NJ, Vakil N. Guidelines for the management of dyspepsia. Am J Gastroenterol. 2005;100:2324–2337.PubMedCrossRef Talley NJ, Vakil N. Guidelines for the management of dyspepsia. Am J Gastroenterol. 2005;100:2324–2337.PubMedCrossRef
7.
go back to reference Zagari RM, Law GR, Fuccio L, Pozzato P, Forman D, Bazzoli F. Dyspeptic symptoms and endoscopic findings in the community: the Loiano-Monghidoro study. Am J Gastroenterol. 2010;105:565–571.PubMedCrossRef Zagari RM, Law GR, Fuccio L, Pozzato P, Forman D, Bazzoli F. Dyspeptic symptoms and endoscopic findings in the community: the Loiano-Monghidoro study. Am J Gastroenterol. 2010;105:565–571.PubMedCrossRef
8.
go back to reference Delaney BC, Qume M, Moayyedi P, et al. Helicobacter pylori test and treat versus proton pump inhibitor in initial management of dyspepsia in primary care: multicentre randomised controlled trial (MRC-CUBE trial). BMJ. 2008;336:651–654.PubMedCrossRef Delaney BC, Qume M, Moayyedi P, et al. Helicobacter pylori test and treat versus proton pump inhibitor in initial management of dyspepsia in primary care: multicentre randomised controlled trial (MRC-CUBE trial). BMJ. 2008;336:651–654.PubMedCrossRef
9.
go back to reference Lam SK. Differences in peptic ulcer between East and West. Baillieres Best Pract Res Clin Gastroenterol. 2000;14:41–52.PubMedCrossRef Lam SK. Differences in peptic ulcer between East and West. Baillieres Best Pract Res Clin Gastroenterol. 2000;14:41–52.PubMedCrossRef
10.
go back to reference Mahadeva S, Raman MC, Ford AC, et al. Gastro-oesophageal reflux is more prevalent in Western dyspeptics: a prospective comparison of British and South-East Asian patients with dyspepsia. Aliment Pharmacol Ther. 2005;21:1483–1490.PubMedCrossRef Mahadeva S, Raman MC, Ford AC, et al. Gastro-oesophageal reflux is more prevalent in Western dyspeptics: a prospective comparison of British and South-East Asian patients with dyspepsia. Aliment Pharmacol Ther. 2005;21:1483–1490.PubMedCrossRef
11.
go back to reference el-Serag HB, Sonnenberg A. Opposing time trends of peptic ulcer and reflux disease. Gut. 1998;43:327–333. el-Serag HB, Sonnenberg A. Opposing time trends of peptic ulcer and reflux disease. Gut. 1998;43:327–333.
12.
go back to reference Ford AC, Marwaha A, Lim A, Moayyedi P. What is the prevalence of clinically significant endoscopic findings in subjects with dyspepsia? Systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2010;8:830–837, 837 e1-e2. Ford AC, Marwaha A, Lim A, Moayyedi P. What is the prevalence of clinically significant endoscopic findings in subjects with dyspepsia? Systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2010;8:830–837, 837 e1-e2.
13.
go back to reference Department of Statistics Malaysia. Population distribution and basic demographic characteristics. The 2000 Population and Housing Census of Malaysia. Putrajaya: Department of Statistics 2000. Department of Statistics Malaysia. Population distribution and basic demographic characteristics. The 2000 Population and Housing Census of Malaysia. Putrajaya: Department of Statistics 2000.
14.
go back to reference Goh KL, Parasakthi N. The racial cohort phenomenon: seroepidemiology of Helicobacter pylori infection in a multiracial South-East Asian country. Eur J Gastroenterol Hepatol. 2001;13:177–183.PubMedCrossRef Goh KL, Parasakthi N. The racial cohort phenomenon: seroepidemiology of Helicobacter pylori infection in a multiracial South-East Asian country. Eur J Gastroenterol Hepatol. 2001;13:177–183.PubMedCrossRef
15.
go back to reference Goh KL, Cheah PL, Md N, Quek KF, Parasakthi N. Ethnicity and H. pylori as risk factors for gastric cancer in Malaysia: a prospective case control study. Am J Gastroenterol. 2007;102:40–45.PubMedCrossRef Goh KL, Cheah PL, Md N, Quek KF, Parasakthi N. Ethnicity and H. pylori as risk factors for gastric cancer in Malaysia: a prospective case control study. Am J Gastroenterol. 2007;102:40–45.PubMedCrossRef
16.
go back to reference Rosaida MS, Goh KL. Gastro-oesophageal reflux disease, reflux oesophagitis and non-erosive reflux disease in a multiracial Asian population: a prospective, endoscopy based study. Eur J Gastroenterol Hepatol. 2004;16:495–501.PubMedCrossRef Rosaida MS, Goh KL. Gastro-oesophageal reflux disease, reflux oesophagitis and non-erosive reflux disease in a multiracial Asian population: a prospective, endoscopy based study. Eur J Gastroenterol Hepatol. 2004;16:495–501.PubMedCrossRef
17.
go back to reference Moayyedi P, Duffett S, Braunholtz D, et al. The Leeds Dyspepsia Questionnaire: a valid tool for measuring the presence and severity of dyspepsia. Aliment Pharmacol Ther. 1998;12:1257–1262.PubMedCrossRef Moayyedi P, Duffett S, Braunholtz D, et al. The Leeds Dyspepsia Questionnaire: a valid tool for measuring the presence and severity of dyspepsia. Aliment Pharmacol Ther. 1998;12:1257–1262.PubMedCrossRef
18.
go back to reference Mahadeva S, Chan WK, Mohazmi M, Sujarita R, Goh KL. Validation study of the Leeds Dyspepsia Questionnaire in a multi-ethnic Asian population. J Gastroenterol Hepatol. 2011;26:1669–1676.PubMedCrossRef Mahadeva S, Chan WK, Mohazmi M, Sujarita R, Goh KL. Validation study of the Leeds Dyspepsia Questionnaire in a multi-ethnic Asian population. J Gastroenterol Hepatol. 2011;26:1669–1676.PubMedCrossRef
19.
go back to reference Goh KL, Parasakthi N, Peh SC, Puthucheary SD, Wong NW. The rapid urease test in the diagnosis of Helicobacter pylori infection. Singapore Med J. 1994;35:161–162.PubMed Goh KL, Parasakthi N, Peh SC, Puthucheary SD, Wong NW. The rapid urease test in the diagnosis of Helicobacter pylori infection. Singapore Med J. 1994;35:161–162.PubMed
20.
go back to reference Myren J, Serck-Hanssen A. The gastroscopic diagnosis of gastritis with particular reference to mucosal reddening and mucus covering. Scand J Gastroenterol. 1974;9:457–462.PubMed Myren J, Serck-Hanssen A. The gastroscopic diagnosis of gastritis with particular reference to mucosal reddening and mucus covering. Scand J Gastroenterol. 1974;9:457–462.PubMed
22.
go back to reference Bernersen B, Johnsen R, Straume B, Burhol PG, Jenssen TG, Stakkevold PA. Towards a true prevalence of peptic ulcer: the Sorreisa gastrointestinal disorder study. Gut. 1990;31:989–992.PubMedCrossRef Bernersen B, Johnsen R, Straume B, Burhol PG, Jenssen TG, Stakkevold PA. Towards a true prevalence of peptic ulcer: the Sorreisa gastrointestinal disorder study. Gut. 1990;31:989–992.PubMedCrossRef
23.
go back to reference Armstrong D, Bennett JR, Blum AL, et al. The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology. 1996;111:85–92.PubMedCrossRef Armstrong D, Bennett JR, Blum AL, et al. The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology. 1996;111:85–92.PubMedCrossRef
24.
go back to reference Johnsen R, Bernersen B, Straume B, Forde OH, Bostad L, Burhol PG. Prevalences of endoscopic and histological findings in subjects with and without dyspepsia. BMJ. 1991;302:749–752.PubMedCrossRef Johnsen R, Bernersen B, Straume B, Forde OH, Bostad L, Burhol PG. Prevalences of endoscopic and histological findings in subjects with and without dyspepsia. BMJ. 1991;302:749–752.PubMedCrossRef
25.
go back to reference Cheli R, Perasso A, Giacosa A. Dyspepsia and chronic gastritis. Hepatogastroenterology. 1983;30:21–23.PubMed Cheli R, Perasso A, Giacosa A. Dyspepsia and chronic gastritis. Hepatogastroenterology. 1983;30:21–23.PubMed
26.
go back to reference Toljamo KT, Niemela SE, Karttunen TJ, Karvonen AL, Lehtola JK. Clinical significance and outcome of gastric mucosal erosions: a long-term follow-up study. Dig Dis Sci. 2006;51:543–547.PubMedCrossRef Toljamo KT, Niemela SE, Karttunen TJ, Karvonen AL, Lehtola JK. Clinical significance and outcome of gastric mucosal erosions: a long-term follow-up study. Dig Dis Sci. 2006;51:543–547.PubMedCrossRef
27.
go back to reference DeLuca VA Jr, Winnan GG, Sheahan DG, et al. Is gastroduodenitis part of the spectrum of peptic ulcer disease? J Clin Gastroenterol. 1981;3:17–22.PubMed DeLuca VA Jr, Winnan GG, Sheahan DG, et al. Is gastroduodenitis part of the spectrum of peptic ulcer disease? J Clin Gastroenterol. 1981;3:17–22.PubMed
28.
go back to reference Danielsson A, Ek B, Nyhlin H, Steen L. The relationship between active peptic ulcer, endoscopic duodenitis and symptomatic state after treatment with cimetidine. Ann Clin Res. 1980;12:4–12.PubMed Danielsson A, Ek B, Nyhlin H, Steen L. The relationship between active peptic ulcer, endoscopic duodenitis and symptomatic state after treatment with cimetidine. Ann Clin Res. 1980;12:4–12.PubMed
29.
go back to reference Williams B, Luckas M, Ellingham JH, Dain A, Wicks AC. Do young patients with dyspepsia need investigation? Lancet. 1988;2:1349–1351.PubMedCrossRef Williams B, Luckas M, Ellingham JH, Dain A, Wicks AC. Do young patients with dyspepsia need investigation? Lancet. 1988;2:1349–1351.PubMedCrossRef
30.
go back to reference American Joint Committee on Cancer. Oesophagus & Stomach. In: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002:91–106. American Joint Committee on Cancer. Oesophagus & Stomach. In: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002:91–106.
31.
go back to reference Noor Ghani S, Yadav H. Health care in Malaysia. Singapore: University of Malaya Press, 2008. Noor Ghani S, Yadav H. Health care in Malaysia. Singapore: University of Malaya Press, 2008.
32.
go back to reference Fraser A, Delaney B, Moayyedi P. Symptom-based outcome measures for dyspepsia and GERD trials: a systematic review. Am J Gastroenterol. 2005;100:442–452.PubMedCrossRef Fraser A, Delaney B, Moayyedi P. Symptom-based outcome measures for dyspepsia and GERD trials: a systematic review. Am J Gastroenterol. 2005;100:442–452.PubMedCrossRef
33.
go back to reference Lu CL, Lang HC, Chang FY, et al. Prevalence and health/social impacts of functional dyspepsia in Taiwan: a study based on the Rome criteria questionnaire survey assisted by endoscopic exclusion among a physical check-up population. Scand J Gastroenterol. 2005;40:402–411.PubMedCrossRef Lu CL, Lang HC, Chang FY, et al. Prevalence and health/social impacts of functional dyspepsia in Taiwan: a study based on the Rome criteria questionnaire survey assisted by endoscopic exclusion among a physical check-up population. Scand J Gastroenterol. 2005;40:402–411.PubMedCrossRef
34.
go back to reference Zhao Y, Zou D, Wang R, et al. Dyspepsia and irritable bowel syndrome in China: a population-based endoscopy study of prevalence and impact. Aliment Pharmacol Ther. 2010;32:562–572.PubMedCrossRef Zhao Y, Zou D, Wang R, et al. Dyspepsia and irritable bowel syndrome in China: a population-based endoscopy study of prevalence and impact. Aliment Pharmacol Ther. 2010;32:562–572.PubMedCrossRef
35.
go back to reference Goh KL, Chang CS, Fock KM, Ke M, Park HJ, Lam SK. Gastro-oesophageal reflux disease in Asia. J Gastroenterol Hepatol. 2000;15:230–238.PubMedCrossRef Goh KL, Chang CS, Fock KM, Ke M, Park HJ, Lam SK. Gastro-oesophageal reflux disease in Asia. J Gastroenterol Hepatol. 2000;15:230–238.PubMedCrossRef
36.
go back to reference Vakil N, Talley N, van Zanten SV, et al. Cost of detecting malignant lesions by endoscopy in 2741 primary care dyspeptic patients without alarm symptoms. Clin Gastroenterol Hepatol. 2009;7:756–761.PubMedCrossRef Vakil N, Talley N, van Zanten SV, et al. Cost of detecting malignant lesions by endoscopy in 2741 primary care dyspeptic patients without alarm symptoms. Clin Gastroenterol Hepatol. 2009;7:756–761.PubMedCrossRef
37.
go back to reference Vakil N, Moayyedi P, Fennerty MB, Talley NJ. Limited value of alarm features in the diagnosis of upper gastrointestinal malignancy: systematic review and meta-analysis. Gastroenterology. 2006;131:390–401; quiz 659–660. Vakil N, Moayyedi P, Fennerty MB, Talley NJ. Limited value of alarm features in the diagnosis of upper gastrointestinal malignancy: systematic review and meta-analysis. Gastroenterology. 2006;131:390–401; quiz 659–660.
38.
go back to reference Hu PJ, Li YY, Zhou MH, et al. Helicobacter pylori associated with a high prevalence of duodenal ulcer disease and a low prevalence of gastric cancer in a developing nation. Gut. 1995;36:198–202.PubMedCrossRef Hu PJ, Li YY, Zhou MH, et al. Helicobacter pylori associated with a high prevalence of duodenal ulcer disease and a low prevalence of gastric cancer in a developing nation. Gut. 1995;36:198–202.PubMedCrossRef
39.
go back to reference Breslin NP, Thomson AB, Bailey RJ, et al. Gastric cancer and other endoscopic diagnoses in patients with benign dyspepsia. Gut. 2000;46:93–97.PubMedCrossRef Breslin NP, Thomson AB, Bailey RJ, et al. Gastric cancer and other endoscopic diagnoses in patients with benign dyspepsia. Gut. 2000;46:93–97.PubMedCrossRef
40.
go back to reference Sung JJ, Lao WC, Lai MS, et al. Incidence of gastroesophageal malignancy in patients with dyspepsia in Hong Kong: implications for screening strategies. Gastrointest Endosc. 2001;54:454–458.PubMedCrossRef Sung JJ, Lao WC, Lai MS, et al. Incidence of gastroesophageal malignancy in patients with dyspepsia in Hong Kong: implications for screening strategies. Gastrointest Endosc. 2001;54:454–458.PubMedCrossRef
41.
go back to reference Wai CT, Yeoh KG, Ho KY, Kang JY, Lim SG. Diagnostic yield of upper endoscopy in Asian patients presenting with dyspepsia. Gastrointest Endosc. 2002;56:548–551.PubMedCrossRef Wai CT, Yeoh KG, Ho KY, Kang JY, Lim SG. Diagnostic yield of upper endoscopy in Asian patients presenting with dyspepsia. Gastrointest Endosc. 2002;56:548–551.PubMedCrossRef
42.
go back to reference Hashemi MR, Rahnavardi M, Bikdeli B, Dehghani Zahedani M. H. pylori infection among, southern Iranian dyspeptic patients. World J Gastroenterol. 2006;1000:5479–5482. Hashemi MR, Rahnavardi M, Bikdeli B, Dehghani Zahedani M. H. pylori infection among, southern Iranian dyspeptic patients. World J Gastroenterol. 2006;1000:5479–5482.
43.
go back to reference Maconi G, Manes G, Porro GB. Role of symptoms in diagnosis and outcome of gastric cancer. World J Gastroenterol. 2008;14:1149–1155.PubMedCrossRef Maconi G, Manes G, Porro GB. Role of symptoms in diagnosis and outcome of gastric cancer. World J Gastroenterol. 2008;14:1149–1155.PubMedCrossRef
44.
go back to reference Drossman DA. The functional gastrointestinal disorders and the Rome III process. Gastroenterology. 2006;130:1377–1390.PubMedCrossRef Drossman DA. The functional gastrointestinal disorders and the Rome III process. Gastroenterology. 2006;130:1377–1390.PubMedCrossRef
45.
go back to reference Mahadeva S, Chia YC, Vinothini A, Mohazmi M, Goh KL. Cost-effectiveness of and satisfaction with a Helicobacter pylori “test and treat” strategy compared with prompt endoscopy in young Asians with dyspepsia. Gut. 2008;57:1214–1220.PubMedCrossRef Mahadeva S, Chia YC, Vinothini A, Mohazmi M, Goh KL. Cost-effectiveness of and satisfaction with a Helicobacter pylori “test and treat” strategy compared with prompt endoscopy in young Asians with dyspepsia. Gut. 2008;57:1214–1220.PubMedCrossRef
Metadata
Title
Clinically Significant Endoscopic Findings in a Multi-Ethnic Population With Uninvestigated Dyspepsia
Authors
Sanjiv Mahadeva
Khean-Lee Goh
Publication date
01-12-2012
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 12/2012
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-012-2256-7

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