Title: Utility of Red Flag Symptoms in Prediction of Malignancy in Elderly Patients with Dyspepsia
Authors: Amol Rajendra Samarth, Bhumit Ramjibhai Patel, Dharmesh Kothari, Nitin Rangrao Gaikwad, Sudhir Jagdish Gupta
DOI: https://dx.doi.org/10.18535/jmscr/v5i10.97
Abstract
Introduction: The elderly vulnerable population is increasing world-wide. Dyspeptic symptoms are common in the general population; with frequencies ranging from 10% to 45%. Red flags or alarm symptoms can be useful to predict malignancy in elderly patients undergoing upper GI endoscopy.
Aim: To evaluate the efficacy of red flag symptoms for prediction of abnormal endoscopic findings, especially malignancy, in elderly population with upper GI symptoms.
Materials and Method: We evaluated 288 consecutive eligible elderly patients undergoing routine upper GI endoscopy (UGIE) for dyspepsia over a period of 1 year, for presence of red flag or alarm symptoms (vomiting, dysphagia, weight loss, blood loss and abdominal lump). Significant co-morbidities were excluded.
Results: Mean age of the patients was 66.81 ±5.32 years. Epigastric pain/discomfort (38.88%) was the most common dyspeptic symptom. Presence of acute (melena or GI bleed) or chronic blood loss, in the form of iron deficiency anemia was the most common (26.38%) alarm (red flag) symptom in the study population. Unintentional weight loss was seen in 20.48% patients, persistent / delayed vomiting was seen in 11.8% while, abdominal lump was present in 2.77% patients. The most common benign findings were gastritis in 38.88% patients, GERD in 17.7% patients, duodenal ulcer in 12.84% and gastric ulcer in 2.08% patients
Overall, 13.19% patients had findings of malignancy on upper GI endoscopy in the form of esophageal malignancy in 8.33% cases, gastric malignancy in 3.12% patients and GE junction malignancy in 1.73%.
Conclusion: The red flag symptom of dysphagia had the highest sensitivity, specificity, positive as well as negative predictive value for occurrence of esophageal malignancy. Finding of significant lesion may be higher in elderly population.
Keywords: Red flags, alarm symptoms, dyspepsia, elderly, upper GI endoscopy.
