Appropriateness of referrals for upper gastrointestinal endoscopy

Uncomplicated dyspepsia has a low predictive value in diagnosing upper gastrointestinal organic disease making early endoscopy essential.

To assess the reliability of clinical information in the diagnosis of organic disease in patients referred for upper gastrointestinal endoscopy.

Patients who were referred for gastroscopy to the Korle Bu Teaching Hospital, in Accra between January and December, 2008 were interviewed and evaluated for this study. The patients' clinical data were correlated with the endoscopic findings to determine how appropriate the referrals were, based on the clinical information.

One thousand, six hundred and forty three patients were studies of whom 372 presented with alarm symptoms. Uncomplicated dyspepsia was the principal presenting symptom in 1271 patients. Overall, 522 (31.8%) patients had organic disease, 440 (26.8%) inflammatory conditions and 681 (41.4%) were negative endoscopies. Two hundred and nine (56.2%) patients with alarm symptoms and 313 (24.6%) without alarm symptoms (p value, OR, 95% CI; <0.001, 3.92, 3.083-5.00) had organic disease. Presentations with bleeding and suspicion of malignancy showed statistical significance with the finding of organic disease while anaemia did not. Dyspepsia was strongly associated with negative endoscopy, 84% vrs 60%, p value <0.001. Gastric malignancies were associated with age 50 years and above. The three common benign diseases of peptic ulcer, gastric ulcer and gastritis showed strong similarity in presentation and were unpredictable clinically.

Patients referred for endoscopy were young in whom there was a high prevalence of organic disease which were mostly benign.