Diagnostic value of alarm symptoms for upper gastrointestinal malignancy in patients referred to gastrointestinal clinic

Journal of Research in Medical Sciences1735-199522020170509Diagnostic value of alarm symptoms for upper gastrointestinal malignancy in patients referred to gastrointestinal clinic1065810658ENInternal medicine School of medicine, Isfahan University of Medical Sciences, Isfahan, Iran School of medicine, Isfahan University of Medical Sciences, Isfahan, IranInternal medicine School of medicine, Isfahan University of Medical Sciences, Isfahan, Iran School of medicine, Isfahan University of Medical Sciences, Isfahan, IranDental Implants Research Center,Oral and Maxillofacial radiology School of dentistry, Isfahan University of Medical Sciences, Isfahan, Iran School of dentistry, Isfahan University of Medical Sciences, Isfahan, Iran20170506Background: Early upper gastrointestinal (UGI) cancer detection had led to organ?preserving endoscopic therapy. Endoscopy is a suitable method of early diagnosis of UGI malignancies. In Iran, exclusion of malignancy is the most important indication for endoscopy. Tis study is designed to see whether using alarm symptoms can predict the risk of cancer in patients. Materials and Methods: A total of 3414 patients referred to a tertiary gastrointestinal (GI) clinic in Isfahan, Iran, from 2009 to 2016 with dyspepsia, gastroesophageal re?ux disease (GERD), and alarm symptoms, such as weight loss, dysphagia, GI bleeding, vomiting, positive familial history for cancer, and anorexia. Each patient had been underwent UGI endoscopy and patient data, including histology results, had been collected in the computer. We used logistic regression models to estimate the diagnostic accuracy of each alarm symptoms. Results: A total of 3414 patients with alarm symptoms entered in this study, of whom 72 (2.1%) had an UGI malignancy. According to the logistic regression model, dysphagia (P < 0.001) and weight loss (P < 0.001) were found to be signifcant positive predictive factors for malignancy. Furthermore, males were in a signifcantly higher risk of developing UGI malignancy. Trough receiver operating characteristic curve and the area under the curve (AUC) with adequate overall calibration and model ft measures, dysphagia and weight loss as a related cancer predictor had a high diagnostic accuracy (accuracy = 0. 72, AUC = 0. 881). Using a combination of age, alarm symptoms will lead to high positive predictive value for cancer. Conclusion: We recommend to do an early endoscopy for any patient with UGI symptoms and to take multiple biopsies from any rudeness or suspicious lesion, especially for male gender older than 50, dysphagia, or weight loss.Key words: Alarm symptom, diagnostic accuracy, upper gastrointestinal malignancyhttp://jrms.mui.ac.ir/index.php/jrms/article/view/10658http://jrms.mui.ac.ir/index.php/jrms/article/download/10658/5489