Alarm features as predictors of major findings in a rural South African upper endoscopic service

Alarm features are commonly used to identify patients who require an endoscopy to rule out significant upper-gastrointestinal (GI) pathology. Validation of these features in a rural South African (SA) setting has implications for the provision of endoscopy services and was the aim of this study.

This was a retrospective chart review of 1 000 consecutive endoscopies performed at a rural SA regional/ referral hospital over three years. Demographic data, indication for endoscopy (upper GI bleed, dyspepsia, dysphagia, anaemia, weight loss, age) and major endoscopic findings (defined any tumour, ulcer, or stricture) were recorded. A multivariate logistic regression analysis was done to identify risk factors for major endoscopic findings.

The median age of the study sample was 51.0 (range14.0-88.0) years. Males (306/1 000) accounted for 30.6% of the study population. The prevalence of alarm features in the study sample was as follows: upper GI bleed - 16.6%; dyspepsia - 58.4%; dysphagia - 10.3%; anaemia - 3.5%; weight loss - 0.3%. The following alarm features were statistically significant in detecting a major endoscopic finding: age > 60 (OR: 2.67, CI: 1.82-3.96), male gender (OR: 1.52, CI: 1.03-2.24), dysphagia (OR: 12.16, CI: 4.33-34.19) and upper GI bleed (OR: 2.77, CI: 1.03-7.47), p < 0.05.

Dysphagia, age > 60, male gender, and upper GI bleed are identifiable risk factors for major endoscopic findings. Not all the alarm features for major endoscopic findings that are established elsewhere can be applied in our rural SA setting.