The yield and the predictors of esophageal pathology when upper endoscopy is used for the initial evaluation of dysphagia
| Autor: | Nicholas J. Nickl, Paul S. Jowell, Rig S. Patel, Shyam Varadarajulu, Eric Libby, Peter B. Cotton, Mohamad A. Eloubeidi, Hugh Mulcahy, Alan N. Barkun, Stephen M. Schutz |
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| Rok vydání: | 2005 |
| Předmět: |
Adult
Male medicine.medical_specialty Pathology Esophageal Neoplasms Esophageal Diseases Gastroenterology Cohort Studies Sex Factors Heartburn Predictive Value of Tests Internal medicine Weight Loss otorhinolaryngologic diseases Medicine Esophagitis Humans Radiology Nuclear Medicine and imaging Endoscopy Digestive System Esophagus Retrospective Studies medicine.diagnostic_test business.industry Esophagogastroduodenoscopy Esophageal disease Age Factors Anatomical pathology Middle Aged medicine.disease Dysphagia Abdominal Pain medicine.anatomical_structure Predictive value of tests Esophageal Stenosis Female medicine.symptom business Deglutition Disorders Odynophagia |
| Zdroj: | Gastrointestinal endoscopy. 61(7) |
| ISSN: | 0016-5107 |
| Popis: | Background The utility of EGD when used as an initial test for the evaluation of dysphagia is unclear. The objective was to determine the yield and the predictive factors of significant pathology when EGD is performed as the initial test to evaluate dysphagia. Methods This is a retrospective analysis of a computerized database. Data on patients who underwent EGD for dysphagia were retrieved from the endoscopy database of 6 endoscopy units. Patients who had undergone prior esophageal evaluation, failed EGD, or who had a history of prior upper-GI pathology were excluded. Univariate and multivariable logistic regression analyses were performed to evaluate any relation between endoscopic findings and presenting clinical features. Results A total of 1649 patients with dysphagia (mean age 56.7 years, standard deviation 16.4; M:F 3:2) were analyzed. Abnormal findings at EGD were found in 70% (1150) of the patients, and a major pathology was seen in 54% (898). Male gender (p=0.0001), heartburn (p=0.0007), and odynophagia (p=0.0001) predicted the presence of major pathology. Cancer was found in 4% (70) of patients and was predicted by male gender (p=0.0002), age (p=0.01), and weight loss (p=0.04). The esophagus was normal in 29% (483) of patients and was predicted by female gender (p=0.0001) and the absence of heartburn (p=0.0004) but not age. There was a lack of details on patients' presentation and clinical history and an absence of long-term clinical follow-up. Conclusions EGD is an effective and an appropriate tool for the initial evaluation of patients presenting with dysphagia. Early EGD should be considered, particularly, in male patients aged more than 40 years old who concomitantly report heartburn, odynophagia, or weight loss. |
| Databáze: | OpenAIRE |
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