Performance of American Society for Gastrointestinal Endoscopy guidelines for dyspepsia in Saudi population: Prospective observational study

Abstract

Author contributions: Azzam NA and Al-hamoudi W carried our majority of study; Almadi MA carried out the analysis and involved in editing the manuscript; Almalki LA, Alrashedi RN, Alghamdi RS and Alamar HH were involved in the study design and editing the manuscript. Abstract AIM: To evaluate adherence of primary care physicians (PCPs) to international guidelines when referring patients for upper-gastrointestinal endoscopy (UGE), evaluate the importance of alarm symptoms and the performance of the American Society for Gastrointestinal Endoscopy (ASGE) guidelines in a Saudi population. METHODS: A prospective, observational cross-sectional study on dyspeptic patients undergoing UGE who were referred by PCPs over a 4 mo period. Refer-rals were classified as appropriate or inappropriate according to adherence to ASGE guidelines. RESULTS: Total of 221 dyspeptic patients was enrolled; 161 patients met our inclusion criteria. Mean age was 40.3 years (SD ± 18.1). Females comprised 70.1%. Alarm symptoms included low hemoglobin level (39%), weight loss (18%), vomiting (16%), loss of appetite (16%), difficulty swallowing (3%), and gastrointestinal bleeding (3%). Abnormal endoscopy findings included gastritis (52%), duodenitis (10%), hiatus hernia (7.8%), features suggestive of celiac disease (6.5%), ulcers (3.9%), malignancy (2.6%) and gastroesophageal reflux disease (GERD: 17%). Among patients who underwent UGE, 63% met ASGE guidelines, and 50% had abnormal endoscopic findings. Endoscopy was not indicated in remaining 37% of patients. Among the latter group, endoscopy was normal in 54% of patients. There was no difference in proportion of abnormal endoscopic findings between two groups (P = 0.639). CONCLUSION: Dyspeptic patients had a low prevalence of important endoscopic lesions, and none of the alarm symptoms could significantly predict abnormal Observational Study ORIGINAL ARTICLE Azzam NA et al. ASGE dyspepsia guidelines performance in Saudis endoscopic findings.