Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2021; 9(15): 3597-3606
Published online May 26, 2021. doi: 10.12998/wjcc.v9.i15.3597
Clinically significant endoscopic findings in patients of dyspepsia with no warning symptoms: A cross-sectional study
Li-Qi Mao, Shuang-Shuang Wang, Yan-Lin Zhou, Lin Chen, Lei-Min Yu, Meng Li, Bin Lv
Li-Qi Mao, Shuang-Shuang Wang, Yan-Lin Zhou, Lin Chen, Lei-Min Yu, Meng Li, Bin Lv, Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
Shuang-Shuang Wang, Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou 317000, Zhejiang Province, China
Lei-Min Yu, Department of Gastroenterology, Guangxing Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310007, Zhejiang Province, China
Author contributions: Mao LQ, Wang SS and Lv B designed the research study; Mao LQ, Wang SS, Zhou YL, Chen L, Yu LM and Li M performed the research; Mao LQ and Wang SS analyzed the data; Mao LQ, Wang SS and Lv B wrote the manuscript.
Supported by the National Natural Science Foundation of China, No. 81770535.
Institutional review board statement: The study was reviewed and approved by the ethics committee of the first affiliated hospital of Zhejiang Chinese Medical University (Approval No. 2017-ZX-052-01).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There is no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bin Lv, MM, Chief Doctor, Professor, Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Shangcheng District, Hangzhou 310006, Zhejiang Province, China. lvbin@medmail.com.cn
Received: January 11, 2021
Peer-review started: January 11, 2021
First decision: February 23, 2021
Revised: February 26, 2021
Accepted: March 29, 2021
Article in press: March 29, 2021
Published online: May 26, 2021
Processing time: 119 Days and 18.5 Hours
Abstract
BACKGROUND

Dyspepsia is one of the commonest clinical disorder. However, controversy remains over the role of endoscopy in patients with dyspepsia. No studies have evaluated the diagnostic value of endoscopy in patients with no warning symptoms according to the Rome IV criteria.

AIM

To study the diagnostic value of endoscopy in dyspeptic patients with no warning symptoms.

METHODS

This cross-sectional study included dyspeptic patients with no warning symptoms who met the inclusion and exclusion criteria at The First Affiliated Hospital, Zhejiang Chinese Medical University from April 2018 to February 2019. The clinical data were collected using questionnaires, including dyspeptic information, warning symptoms, other diseases, family history and basic demographic data. Based on dyspeptic symptoms, patients can be divided into epigastric pain syndrome, postprandial distress syndrome or overlapping subtypes.

RESULTS

A total of 1016 cases were enrolled, 304 (29.9%) had clinically significant findings that were detectable by endoscopy. The endoscopy findings included esophageal lesions in 180 (17.7%) cases, peptic ulcers in 115 (11.3%) cases and malignancy in 9 (0.89%) patients. Multivariate logistic regression analysis showed that males [odds ratio (OR) = 1.758, P < 0.001], body mass index > 25 (OR = 1.660; P = 0.005), epigastric pain (OR = 1.423; P = 0.019) and Helicobacter pylori infection (OR = 1.949; P < 0.001) were independently associated with risk factors for the presence of clinically significant findings on endoscopy.

CONCLUSION

Chinese patients with dyspepsia with no warning symptoms should undergo endoscopy, particularly males, patients with body mass index > 25, epigastric pain or Helicobacter pylori infection.

Keywords: Rome IV; Dyspepsia; Questionnaire; Endoscopy; Warning symptoms; Diagnosis

Core Tip: We found that the incidence rate of malignancy (0.89%) among dyspeptic patients with no warning symptoms was high. Moreover, the prevalence of significant endoscopic findings did not increase with age, but the incidence rate of malignancy (1.40%) was relatively higher in patients ≥ 50 years of age. Furthermore, the data suggested that male gender, body mass index > 25, epigastric pain and Helicobacter pylori infection were independently associated with significant endoscopic findings. Therefore, endoscopy should be the initial management strategy for dyspeptic Chinese patients even in the absence of warning features.