Lee Shou-Wu, Chang Chi-Sen, Yeh Hong-Jeh, Lien Han-Chung, Lee Teng-Yu, Peng Yen-Chun
Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China.
Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China.
Gastroenterology Res. 2017 Apr;10(2):120-125. doi: 10.14740/gr826w. Epub 2017 Apr 19.
Upper gastrointestinal (GI) malignancies are an uncommon cause of dyspepsia but of great concern. The aim of this study was to determine the association between alarm features and each type and stage of upper GI malignancies.
Patients who underwent endoscopy for symptoms of dyspepsia between January 2008 and December 2009 were retrospectively collected. Alarm features studied in this study were dysplasia, body weight loss and GI bleeding. Patients were classified according to the findings of endoscopy and histological reports.
A total of 3,926 patients were included in the study, with 82 (2.1%) cases with GI malignancies. The specificity and negative predictive value of alarm features ranged from 93.8% to 99.8%, but the sensitivity and positive predictive value ranged from 11.6% to 29.3%. The only variable with a positive predictive value was dysphagia (66.7%). The patients with esophageal cancers and upper gastric cancers had the highest ratio of alarm features, most body weight loss and dysphagia. There was a positive correlation between alarm features and advanced stages of gastric cancers, with the exception of GI bleeding sign.
Although alarm features had a low sensitivity in identifying patients with upper GI malignancies, the presence of alarm features did help diagnose esophageal or upper gastric cancer and the sign of GI bleeding for early gastric cancer. In addition, dysphagia and weight loss are associated with higher stages of gastric cancer.
上消化道（GI）恶性肿瘤是消化不良的少见病因，但备受关注。本研究旨在确定报警特征与上消化道恶性肿瘤各类型及分期之间的关联。
回顾性收集2008年1月至2009年12月因消化不良症状接受内镜检查的患者。本研究中研究的报警特征为发育异常、体重减轻和消化道出血。根据内镜检查结果和组织学报告对患者进行分类。
本研究共纳入3926例患者，其中82例（2.1%）患有消化道恶性肿瘤。报警特征的特异性和阴性预测值在93.8%至99.8%之间，但敏感性和阳性预测值在11.6%至29.3%之间。唯一具有阳性预测值的变量是吞咽困难（66.7%）。食管癌和胃上部癌患者的报警特征比例最高，体重减轻和吞咽困难最为常见。除消化道出血体征外，报警特征与胃癌晚期呈正相关。
尽管报警特征在识别上消化道恶性肿瘤患者时敏感性较低，但报警特征的存在确实有助于诊断食管癌或胃上部癌以及早期胃癌的消化道出血体征。此外，吞咽困难和体重减轻与胃癌的较高分期相关。
