Dyspepsia: Should all patients undergo endoscopy?

Area of Science:

• Gastroenterology
• Diagnostic Endoscopy

Background:

• The diagnostic utility of endoscopy for dyspepsia remains unclear, with varied international findings.
• Conflicting reports exist, particularly from Western countries, necessitating further investigation.

Purpose of the Study:

• To evaluate the effectiveness of endoscopy in diagnosing dyspepsia across different age groups.
• To determine optimal age-based criteria for routine endoscopic examination in dyspepsia patients.

Main Methods:

• A prospective study involving 732 patients presenting with dyspepsia.
• Patients were stratified into two age groups: younger (≤45 years) and older (>45 years).
• All participants underwent upper gastrointestinal endoscopy.

Main Results:

• Endoscopic abnormalities were found in 16% of younger patients (n=92/567), primarily minor conditions like peptic ulcers.
• A significantly higher rate of abnormalities (42%, n=69/165) was observed in older patients (p<0.001).
• Gastric carcinomas were identified in 9% of older patients (n=15/165).

Conclusions:

• Routine endoscopy for dyspepsia is most beneficial for patients aged 45 and above.
• Implementing age-based endoscopy selection can reduce the burden on endoscopy services.
• This strategy improves cost-effectiveness and focuses resources on higher-risk patient groups.