Dyspepsia in Korean Population: Who Needs Endoscopy?

Lee, Jun Ho; Kim, Hak Yang; Rho, Seung Hyuck; Yoon, Duck Hyong; Kim, Kyung Ho; Choi, Jong Hyung; Lee, Ja Young; Kim, Auk; Lee, Jin Heon; Kim, Yong Bum; Yoo, Jae Young

Abstract

BACKGROUND/AIMS: Dyspepsia is remarkably common in the general population. Although upper gastrointestinal endoscopy is the investigation of choice for dyspepsia, the selection of the patients who need endoscopy is very difficult. This study was aimed to investigate the usefulness of the various parameters for the selection of the patients who need endoscopy in Korean population.
METHODS
An analysis of the endoscopic findings was carried out in 141 patients with dyspepsia according to parameters including H. pylori IgG seropositivity, age and alarm signs, such as dysphagia, weight loss, vomiting, anemia, family history of upper gastrointestinal malignancy, hematemesis or melena, abdominal mass and anorexia.
RESULTS
The positive rates of stomach cancer and peptic ulcer in patients above 35 years of age were 3% (4/118) and 30% (35/118), respectively. The positive rates of stomach cancer and peptic ulcer in patients with alarm signs were 2% (2/94), 36% (34/94) and the rates in patients with H. pylori IgG seropositivity were 4% (3/70), 37% (26/70), respectively. However, no parameter was useful in the selection of patients with stomach cancer or peptic ulcer. In patients with alarm signs, the positive rates of peptic ulcer in patients with and without H. pylori IgG seropositivity were 46% (22/48) and 26% (12/46), respectively (p=0.04). In patients under 35 years of age, the positive rates of peptic ulcer in patients with and without H. pylori IgG seropositivity were 58% (7/12) and 18% (2/11), respectively (p=0.048).
CONCLUSIONS
The overall positive rates of stomach cancer or peptic ulcer were significantly higher in patient group with both H. pylori IgG seropositivity and alarm signs, and that under 35 years of age with H. pylori IgG seropositivity. However, there were also considerable number of peptic ulcer in patients who were excluded from those groups. We recommend that those parameters should be used only as a decision aid in selecting the candidates for endoscopy.