Can the indications for gastroscopy in dyspeptic patients be tightened?

Gastroscopy is frequently performed to investigate upper gastrointestinal (GI) symptoms. This analysis aimed to identify upper GI symptoms associated with clinically significant pathology, low-yield gastroscopies and opportunities to refine future referral guidelines.

This retrospective study analysed symptomatic gastroscopies performed at two public hospitals between 15 January 2024 and 31 October 2024, using data from a patient registry. The association of patient age, sex and symptoms with clinically significant pathology was examined using a binary logistic regression model.

Altogether 643 gastroscopies were analysed. About 60.0% were performed on female patients, and 22.4% on patients aged <50 years. Significant pathology was found in 152 gastroscopies (overall 23.6%; females 19.2%; males 30.4%). The highest proportions of significant pathology were observed in patients with weight loss (34.9%), dysphagia (32.4%) or anaemia (26.8%). These symptoms were associated with higher odds of detecting significant pathology compared to dyspepsia (adjusted odds ratio [aOR] 2.83, p < 0.01, weight loss vs. dyspepsia; aOR 2.46, p < 0.01, dysphagia vs. dyspepsia; aOR 1.94, p = 0.043, anaemia vs. dyspepsia). In patients aged <50 years, significant pathology was identified in 6.7% of those with vomiting and 3.3% of those with reflux.

Weight loss, dysphagia and anaemia should continue to trigger investigation in all patients. Reflux and vomiting were considered low-yield symptoms in patients aged <50 years, indicating opportunities for more efficient allocation of resources. Further prospective follow-up studies are needed to assess the role of gastroscopy in patients aged 55-60 years with dyspepsia and in patients aged <50 years with reflux or vomiting.