A prediction study between patients with the presence of alarm symptoms and organic pathology in upper gastrointestinal tract endoscopy

Year 2015, Volume: 23 Issue: 2, 44 - 49, 29.08.2015

Aslı Bilen Hakan Demirdağ Emrullah Erdem Süleyman Coşgun Refik Demirtunç

https://doi.org/10.17940/endoskopi.468248

Abstract

Background and Aims: The absence of alarm symptoms in young patients
with dyspepsia are considered to be safe markers for the absence of malignancy.
However, the positive predictive value of alarm symptoms is weak,
respectively. In this study, we aimed to evaluate the diagnostic value of alarm
symptoms for upper gastrointestinal system malignancies and to determine
if there are different criteria that predict upper gastrointestinal system malignancy
as well as alarm symptoms. Materials and Methods: To evaluate
the presence of alarm symptoms in patients undergoing upper gastrointestinal
system endoscopy for various reasons, we prepared and administered
a questionnaire in 200 patients, 18-70 years of age, who were seen at the
Endoscopy Unit of Haydarpasa Numune Hospital between July 1, 2011 and
Dec 15, 2012. Sensitivities, selectivities, and positive and negative predictive
values of the presence of any alarm symptom were calculated to predict upper
gastrointestinal system malignancy. Results: Prevalence of upper gastrointestinal
system malignancy was found to be 3.5% in the study. Positive and
negative predictive values for the presence of any alarm symptom, and each
individual alarm symptom, were determined to be fewer and more, respectively.
A statistically significant correlation was seen among upper gastrointestinal
system malignancy and cases with weight loss, jaundice, abdominal
mass or lymphadenopathy. Using logistic regression analysis, we analyzed
the effects of the following parameters (≥ 45 years of age, dysphagia, weight
loss, anorexia, jaundice and gastric surgery history) in the diagnosis of malignancy;
the relation with malignancy was found to be statistically significant
(p: 0,002; p<0.01). Conclusion: In conclusion, our results showed that the
diagnostic value of alarm symptoms were less than optimal. A study of a
larger case series is required to determine the most efficient combination of
alarm symptoms and other factors.

Keywords

Malignancy, endoscopy

Üst gis endoskopi yapılacak hastalarda alarm semptom varlığı ile organik patoloji arasındaki prediksiyon çalışması

Abstract

Giriş ve Amaç: Dispepsili genç hastalarda alarm semptomlarının olmaması
malignite yokluğuna dair güvenilir bir gösterge olarak kabul edilmektedir.
Ancak alarm semptomlarının pozitif prediktif değeri nispeten zayıf kalmaktadır.
Bu çalışmadaki amacımız alarm semptomlarının üst gastrointestinal
sistem maligniteleri için tanısal değerini ve alarm semptomlarının yanısıra
üst gastrointestinal sistem malignitelerini predikte eden farklı kriterlerler
olup olmadığını araştırmaktır. Gereç ve Yöntem: 01.07.2011 ile 15.12.2012
tarihleri arasında Haydarpaşa Numune EAH Endoskopi Ünitesi’ne çeşitli nedenlerle
üst gastrointestinal sistem endoskopisi yapılması amacıyla yönlendirilen
18-70 yaş arasında 200 hastaya hazırlamış olduğumuz anket yapılarak
alarm semptomlarının olup olmadığı sorgulandı. Herhangi bir alarm semptomu
varlığının ve tek tek alarm semptomlarının üst gastrointestinal sistem
malignite prediksiyonu açısından duyarlılıkları, seçicilikleri, pozitif prediktif
değerleri ve negatif prediktif değerleri hesaplandı. Bulgular: Çalışmada üst
gastrointestinal sistem malignite prevalansı %3.5 olarak bulundu. Malignite
görülen olguların tamamında herhangi bir alarm semptomu tespit edilirken,
malignitesi olmayan olgularda alarm semptomu görülme oranı %91.2 idi.
Herhangi bir alarm semptomu varlığının ve her bir alarm semptomunun
pozitif prediktif değeri düşük, negatif prediktif değeri yüksek saptandı. Maligniteli
olguların %28’i iyi differansiye, %28’i orta differansiye, %44’ü az
differansiye idi. Üst gastrointestinal sistem malignitesi ile kilo kaybı olan ve
sarılık, abdominal kitle ya da lenfadenopati olan olgular arasında istatistiksel
açıdan anlamlı ilişki saptandı. Malignite tanısına 45 yaş ve üstünde olmak,
disfaji, kilo kaybı, anoreksi, sarılık ve gastrik cerrahi öykü parametrelerinin
etkilerini lojistik regresyon analizi ile değerlendirdiğimizde malignite
ile ilişkileri istatistiksel olarak anlamlı (p: 0.002; p<0.01) bulundu. Sonuç:
Sonuç olarak, bulgularımız alarm semptomlarının tanısal değerinin optimal
olmadığını gösterdi. En etkin (alarm semptomları ve diğer faktörlerin) kombinasyonun
tanımlanması için daha geniş olgu serilerine sahip çalışmalara
ihtiyaç vardır.

Keywords

Malignite, endoskopi

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