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Gastroscopy in younger patients: an analysis of referrals and pathologies
Noora Räsänen1, Michiel van Nieuwenhoven
1Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Insights
National guidelines for dyspepsia investigation in patients under 50 were poorly followed. Esophagogastroduodenoscopy (EGD) in young adults often revealed no significant pathology, with most serious findings originating from hospital referrals.
Area of Science:
- Gastroenterology
- Clinical Medicine
- Diagnostic Procedures
Background:
- Diagnostic guidelines exist for investigating dyspepsia in patients under 50 years old.
- Adherence to these national guidelines for uninvestigated dyspepsia is uncertain.
- Prevalence of upper gastrointestinal pathology in patients aged 18-50 requires examination.
Purpose of the Study:
- Investigate adherence to national guidelines for uninvestigated dyspepsia.
- Determine the prevalence of upper gastrointestinal pathology in patients aged 18-50.
- Identify risk factors for pathology in esophagogastroduodenoscopy referrals.
- Compare referrals from hospital versus primary healthcare settings.
Main Methods:
- Retrospective review of medical records for patients undergoing esophagogastroduodenoscopy (EGD) from January 2019 to April 2020.
- Statistical analysis included odds ratios (OR), positive predictive values (PPV), negative predictive values (NPV), chi-square, and Mann-Whitney U-tests.
- 1708 patients were included in the analysis.
Main Results:
- 43.6% of patients (744/1708) had a pathologic finding on EGD.
- The 41-50 age group showed the highest prevalence (OR 1.34).
- Helicobacter pylori testing was infrequent (21.1%) in patients without alarm symptoms.
- High negative predictive value (98.7-99.6%) for significant pathology was observed in the absence of alarm symptoms.
- Significant pathology was predominantly found in hospital-based referrals.
Conclusions:
- Esophagogastroduodenoscopy is frequently performed in young adults, often yielding non-significant findings.
- Adherence to national diagnostic guidelines for dyspepsia was suboptimal.
- No specific referral factors were strongly associated with increased risk of significant pathology.
- EGD referrals from primary healthcare primarily identified benign pathology, while significant findings were almost exclusively from hospital referrals.
Background And Aim:
Diagnostic guidelines for the investigation of dyspepsia for patients <50 years have been implemented. However, it is unsure whether these guidelines are used appropriately. We aimed to investigate the adherence to the national guidelines of uninvestigated dyspepsia and to examine the prevalence of upper gastrointestinal pathology in patients 18-50 years. We also aimed to detect any possible risk factors for pathology in esophagogastroduodenoscopy referrals and to evaluate differences between referrals from the hospital and primary health care.
Method:
This is a retrospective review of medical records including patients who underwent esophagogastroduodenoscopy between January 2019 and April 2020 (n = 1809). Odds ratios (OR), positive predictive values (PPV), negative predictive values (NPV), chi-square and Mann-Whitney U-tests were applied.
Results:
In total 1708 patients were included, of whom 43.6% (n = 744) had a pathologic finding. Age group 41-50 years showed the highest prevalence with an OR 1.34 [95% confidence interval (CI), 1.07-1.69]. Helicobacter pylori testing was performed in 21.1% (n = 167) of patients with dyspepsia lacking alarm symptoms (n = 791). PPV and OR were generally low for a pathologic esophagogastroduodenoscopy. The absence of alarm symptoms showed a high NPV for significant pathology (98.7-99.6%). Significant pathology was almost exclusively found in hospital-based referrals.
Conclusions:
Esophagogastroduodenoscopy is widely performed in young adults, often without significant findings. Adherence to the national guidelines was poor. No referral factors were associated with a significant risk for a pathologic finding. Esophagogastroduodenoscopy based on primary healthcare referrals demonstrated almost exclusively benign pathology. Significant pathology was only found via hospital-based referrals.
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