Does concern about missing malignancy justify endoscopy in uncomplicated dyspepsia in patients aged less than 55?

Objective: There is increasing interest in using noninvasive H. pylori test ing rather than endoscopy in determining the management of younger patients presenting with dyspepsia, However, there is concern that this approach ma g result in missing potentially curable malignancy. The aim of the study wa s therefore to assess whether concern over occult malignancy is valid in pa tients aged <55 yr presenting with uncomplicated dyspepsia, Methods: A pred etermined questionnaire was used to review the case notes of patients aged <55 yr who had presented with esophageal or gastric cancer between 1989 and 1993 within the Greater Glasgow Health Board population of 940,000, Result s: A total of 169 patients aged <55 yr were diagnosed to have gastroesophag eal malignancy over the 5-yr period, representing an incidence of about 1 p er 28,000 total population/yr, There were only five patients who were found to have upper GI malignancy when undergoing upper GI investigation in the absence of sinister symptoms. This represents an incidence of underlying ma lignancy in patients of <55 yr with uncomplicated dyspepsia of 1.06 per mil lion total population/yr. Of these five patients, all had lymph node metast ases at diagnosis and four had died between 2 months and 3 yr of follow-up, Conclusions: Upper GI malignancy is extremely rare in patients <55 yr pres enting with uncomplicated dyspepsia and, when found, is usually incurable. Consequently, concern about missing underlying curable malignancy is not a valid indication for endoscoping patients <55 yr presenting with uncomplica ted dyspepsia, (C) 1999 by Am. Cell, of Gastroenterology.