Gastric cancer and other endoscopic diagnoses in patients with benign dyspepsia

Background-It has been suggested that endoscopy could be replaced with noni nvasive assessment of helicobacter status in the initial work up of young d yspeptic patients without sinister symptoms. Aims-To determine the incidence of gastro-oesophageal malignancy in young d yspeptic patients. Methods-The Alberta Endoscopy Project captured clinical and demographic dat a on all endoscopies performed from April 1993 to February 1996 at four maj or adult hospitals in Alberta. The endoscopic and histological diagnosis in a subgroup of patients under 45 years of age without alarm symptoms that h ad undergone gastroscopy was reviewed. In addition, a random list of 200 pa tients was generated and their medical records reviewed in order to assess the proportion with symptoms suitable for a non-invasive management strateg y. Results-Gastroscopy was performed in 7004 patients under 45 years. In 3634 patients (56% female) alarm type symptoms were absent; 78.9% of patients ha d symptoms amenable to a non-invasive initial approach, giving a corrected sample size of 2867 patients (correction factor 0.789). Three gastric cance rs, one case of moderate dysplasia, 10 biopsy proved cases of Barrett's oes ophagus, and 19 oesophageal strictures/rings were detected within this samp le. The corrected prevalence of gastric cancer in this select population wa s 1.05 per thousand patients. Discussion-Endoscopy yielded three gastric cancers in this sample of under 45 year old dyspeptic patients without sinister symptoms. While initial non -invasive Screening with one-week triple therapy for helicobacter positive individuals is unlikely to have a detrimental outcome the physician is advi sed to consider endoscopy in patients with persisting, recurrent, or sinist er symptoms.