Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Medicine, Division of Gastroenterology, McMaster University, Hamilton, Canada.
Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Clin Gastroenterol Hepatol. 2023 Jul;21(7):1739-1749.e2. doi: 10.1016/j.cgh.2022.05.041. Epub 2022 Jun 20.
BACKGROUND & AIMS: The prevalence of clinically significant endoscopic findings in people with dyspepsia and understanding how symptoms can predict endoscopic pathology can help inform dyspepsia guidelines. We evaluated this in an updated systematic review and meta-analysis.
We searched MEDLINE, EMBASE, Cochrane CENTRAL, and the Cochrane Database of Systematic Reviews from 2010 through to January 2022 to identify relevant articles. Eligible studies enrolled adults from the community, workplace, blood donation or screening clinics, family physician offices, or internal medicine clinics. Studies were required to report prevalence of dyspepsia and perform esophagogastroduodenoscopy (EGD). Prevalence of clinically significant endoscopic findings in subjects with and without dyspepsia was pooled for all studies and compared using odds ratios and 95% confidence intervals (CIs). The data were pooled with those of the 9 studies included in the prior review.
Of 511 papers evaluated, 184 reported prevalence of dyspepsia. Fifteen reported prevalence of endoscopic findings among 41,763 participants (40.4% with dyspepsia). Erosive esophagitis was the most common abnormality (pooled prevalence, 11.0%; 95% CI, 8.9%-13.2%) followed by peptic ulcer (pooled prevalence, 4.4%; 95% CI, 2.5%-6.7%). The only finding encountered more frequently in individuals with dyspepsia, compared with those without, was peptic ulcer (odds ratio, 1.61; 95% CI, 1.08-2.39). More than 85% of EGDs were completely normal. Gastroesophageal cancer was rare (<0.4%) and equally prevalent among those with and without dyspepsia.
Erosive esophagitis was the most common clinically significant finding at EGD, whereas gastroesophageal cancers were rare. Most pathology, including esophagitis and cancer, were found in similar proportions in both groups. These findings support noninvasive approaches to managing dyspepsia in the community, with EGD reserved for those at high risk of malignancy.
消化不良患者中出现有临床意义的内镜表现的患病率，以及了解症状如何预测内镜病理，这有助于为消化不良指南提供信息。我们在一项更新的系统评价和荟萃分析中对此进行了评估。
我们检索了 MEDLINE、EMBASE、Cochrane 中心、Cochrane 系统评价数据库，从 2010 年到 2022 年 1 月，以确定相关文章。合格的研究纳入了来自社区、工作场所、献血或筛查诊所、家庭医生办公室或内科诊所的成年人。研究需要报告消化不良的患病率，并进行食管胃十二指肠镜检查（EGD）。所有研究均汇总了有和无消化不良症状患者的有临床意义的内镜表现患病率，并使用比值比和 95%置信区间（CI）进行比较。这些数据与之前综述中纳入的 9 项研究的数据进行了汇总。
在评估的 511 篇论文中，有 184 篇报告了消化不良的患病率。15 项研究报告了 41763 名参与者中内镜表现的患病率（40.4%有消化不良）。糜烂性食管炎是最常见的异常（汇总患病率为 11.0%；95%CI，8.9%-13.2%），其次是消化性溃疡（汇总患病率为 4.4%；95%CI，2.5%-6.7%）。在有消化不良的个体中，唯一比没有消化不良的个体更常见的发现是消化性溃疡（比值比，1.61；95%CI，1.08-2.39）。超过 85%的 EGD 完全正常。胃食管癌症很少见（<0.4%），在有和无消化不良的个体中患病率相似。
糜烂性食管炎是 EGD 最常见的有临床意义的表现，而胃食管癌症则很少见。大多数病理表现，包括食管炎和癌症，在两组中的比例相似。这些发现支持在社区中采用非侵入性方法来管理消化不良，仅将 EGD 保留用于恶性肿瘤风险高的患者。
