Age is a predictor of significant endoscopic findings in dyspepsia patients in South Africa
Dyspepsia is the commonest indication for endoscopy. Current American guidelines recommend that all dyspepsia patients ≥ 60 years undergo endoscopy to exclude significant pathology.
To provide an epidemiological analysis of dyspepsia in the South African context, and to determine whether age ≥ 60 is a predictor of significant endoscopic findings .
A retrospective chart review of 1000 consecutive endoscopies done at Madadeni Provincial Hospital, KwaZulu-Natal, from 2014 to 2016 was performed. All patients with dyspepsia were identified and divided into age ≥ 60 and < 60 cohorts. Demographic data, significant endoscopic findings (tumour, ulcer, and stricture) and non-significant findings (gastritis, hiatus hernia, candidiasis, and oesophagitis, normal) were recorded.
584 patients (58.4%) presented with dyspepsia, with a median age of 49 years (interquartile range: 14-87). There were 142 males (24.4%) and 442 females (75.6%) and 432 (74%) patients in the age < 60 cohort and 152 (26%) in the age ≥ 60 cohort. In the age < 60 cohort, 6.7% (29/432) had significant findings compared to 17.1% (26/152) of patients in the age ≥60 cohort (OR: 2.8675, CI 0.95: 1.6823 - 5.0498, p =0.0003). The overall prevalence of functional dyspepsia findings was n=161 (27.5%). There was a significantly higher percentage of functional dyspepsia in the < 60 age group than in the ≥ 60 age group (31% vs 17.1%) (OR: 2.2028, CI 0.95: 1.3786 – 3.5197, p =0.001).
Age ≥ 60 years is a predictor of significant endoscopic findings in dyspepsia patients in South Africa. We recommend that South African guidelines be amended to increase the age cut-off from 45 years to ≥ 60 years.
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