Department of Surgery, Madadeni Hospital, University of KwaZulu-Natal, South Africa.
Faculty of Health and Environmental Sciences, Central University of Technology, South Africa.
S Afr J Surg. 2020 Mar;58(1):14-17.
Dyspepsia is the commonest indication for endoscopy. Current American guidelines recommend that all dyspepsia patients ≥ 60 years undergo endoscopy to exclude significant pathology. The use of this age cut-off has never been analysed in South Africa. We aimed to compare different age cut-offs as predictors of significant endoscopic findings in patients with a primary diagnosis of dyspepsia.
A retrospective chart review of 1 000 consecutive endoscopies done at Madadeni Provincial Hospital, KwaZulu-Natal, from 2014 to 2016 was performed. All patients with dyspepsia were identified and divided into age ≥ 60 and < 60 cohorts and < 45 and ≥ 45 cohorts. Demographic data, significant endoscopic findings (tumour, ulcer, and stricture) and non-significant findings (gastritis, hiatus hernia, candidiasis, and oesophagitis, normal) were recorded.
584 patients (58.4%) presented with dyspepsia, with a median age of 49 years (interquartile range: 14-87). There were 142 males (24.4%) and 442 females (75.6%). 432 (74%) patients in the age < 60 cohort and 152 (26%) in the age ≥ 60 cohort . There were 238 (41%) patients in the < 45 cohort and 346 (59%) patients in the ≥ 45 cohort. In the age < 60 cohort, 6.7% of patients had significant findings, compared to 17.1% of patients in the age ≥ 60 cohort (-value < 0.001). In the age ≥ 60 cohort, the positive predictive value (PPV) of endoscopy was 17%, negative predictive value (NPV) (93%) and odds ratio (OR) (2.87) < 0.001. In the age < 45 cohort, 4.2% of patients had significant findings, compared to 13% of patients in the ≥ 45 cohort (-value < 0.001). In the age ≥ 45 cohort, the PPV was 13%, NPV (96%) and OR (3.41) < 0.001. There is no overall difference in significant endoscopic findings between the age ≥ 45 and age ≥ 60 groups ( = 0.230).
Age is a predictor of significant endoscopic findings in dyspepsia patients. Patients ≥ 60 years with dyspepsia symptoms should undergo a routine endoscopy in the absence of alarm symptoms. The current ACG guidelines can be applied in the South African context.
消化不良是内镜检查最常见的指征。目前的美国指南建议所有 60 岁以上的消化不良患者进行内镜检查以排除明显的病理。南非从未对这一年龄界限进行过分析。我们旨在比较不同的年龄界限作为预测消化不良患者有意义内镜发现的指标。
对 2014 年至 2016 年在夸祖鲁-纳塔尔省马达丹尼省医院进行的 1000 例连续内镜检查进行了回顾性图表审查。确定所有有消化不良症状的患者，并将其分为年龄≥60 岁和<60 岁组和<45 岁和≥45 岁组。记录人口统计学数据、有意义的内镜发现（肿瘤、溃疡和狭窄）和无意义的发现（胃炎、食管裂孔疝、假丝酵母菌病和食管炎，正常）。
584 例（58.4%）患者出现消化不良，中位年龄为 49 岁（四分位距：14-87）。男性 142 例（24.4%），女性 442 例（75.6%）。<60 岁年龄组中 432 例（74%）患者和≥60 岁年龄组中 152 例（26%）患者。<45 岁年龄组中有 238 例（41%）患者，≥45 岁年龄组中有 346 例（59%）患者。在<60 岁年龄组中，有 6.7%的患者有明显的发现，而在≥60 岁年龄组中，有 17.1%的患者有明显的发现（-值<0.001）。在年龄≥60 岁的队列中，内镜检查的阳性预测值（PPV）为 17%，阴性预测值（NPV）（93%）和比值比（OR）（2.87）<0.001。在<45 岁年龄组中，有 4.2%的患者有明显的发现，而在≥45 岁年龄组中，有 13%的患者有明显的发现（-值<0.001）。在≥45 岁年龄组中，PPV 为 13%，NPV（96%）和 OR（3.41）<0.001。在≥45 岁和≥60 岁年龄组之间，内镜检查的显著发现之间没有总体差异（=0.230）。
年龄是消化不良患者有意义内镜发现的预测指标。没有报警症状的 60 岁以上消化不良患者应进行常规内镜检查。目前的 ACG 指南可以在南非的情况下应用。
