Age- and Risk-Based Stratification in Dyspepsia: Redefining Endoscopic Thresholds for Clinically Significant and...

Area of Science:

• Gastroenterology
• Diagnostic Endoscopy
• Oncology

Background:

• Dyspepsia is a frequent reason for gastroscopy.
• The diagnostic yield for malignancy and clinically significant findings (CSF) is often low.
• Improved risk stratification is needed for endoscopic referral.

Purpose of the Study:

• To evaluate the diagnostic yield of gastroscopy in dyspepsia patients.
• To investigate the predictive value of age, ethnicity, and alarm symptoms for CSF and malignancy.

Main Methods:

• Retrospective single-center study of 3022 patients undergoing gastroscopy for dyspepsia.
• Multivariate logistic regression to identify predictors of CSF.
• Receiver operating characteristic (ROC) analysis for optimal age thresholds.

Main Results:

• Functional dyspepsia in 55.9%; precancerous lesions in 12.8%; malignancy in 0.79%.
• Age ≥ 50 years and alarm symptoms independently predicted CSF and malignancy.
• Optimal age thresholds: 50 for CSF (AUC=0.65), 54 for malignancy (AUC=0.72).

Conclusions:

• Age ≥ 50 and alarm symptoms are key predictors for CSF and malignancy in dyspepsia.
• Supports a selective approach to gastroscopy referrals.
• ROC-derived age thresholds may inform region-specific risk stratification strategies.