Age and Alarm Symptoms Predict Upper Gastrointestinal Malignancy Among Patients with Dyspepsia

Background: Upper gastrointestinal (UGI) Malignancy is one of the major causes of cancer related death. Endoscopy in dyspeptic patients above 45 years, or those with alarm symptoms may detect this condition. There were only limited data in Indonesia about age and alarm symptoms to predict UGI Malignancy. This study was aimed to determine the prevalence of UGI Malignancy among dyspepsia patients and to develop a simple clinical prediction model.Method: A cross-sectional study to 390 patients with dyspepsia underwent endoscopy in Endoscopy Unit of Sanglah Hospital Denpasar between July 2012 and June 2013 was conducted. Demography and alarm symptoms were documented. Chi-square and logistic regression test analysis were conducted to analyze variables associated with UGI Malignancy.Results: Twenty (5.13%) of 390 patients with dyspepsia had UGI Malignancy. Of the 20 patients, 65% were gastric cancer and 30% were esophageal cancer. The mean age was 59 ± 12 years. Variables associated with UGI Malignancy were weight loss (OR = 8.2), dysphagia (OR = 6.2), age > 45 years old (OR = 5.6), gastrointestinal bleeding (OR = 5.5), persistent vomiting (OR = 5.4), and anemia (OR = 4.9). Using a simplified rule of age >45 years and the presence of any alarm symptom, sensitivity was 85% and specificity was 67.57%.Conclusions: UGI Malignancy was found in 5.13% of patients with dyspepsia who underwent endoscopy. Simple clinical prediction model states that age above 45 years and alarm symptoms may be used as a screening tool to predict UGI Malignancy

CASE REPORT: LIVER CIRRHOSIS

Liver cirrhosis is a state of the accumulation of extracellular matrix or scar tissue in response to acute or chronic liver injury. The causes are varied, but the majority of patients with chronic liver disease caused by a virus or drinking alcohol. Liver cirrhosis often occur without symptoms and found during routine examination, but in advanced complications such as liver failure and portal hypertension can arise. Therapy in patients with liver cirrhosis aims to reduce the progression of diseases such as prevent further liver damage, prevention, and complications management. </p

Fasting Gastric Acidity Evidential Effect on Esophageal Mucosal Damage

Gastric substances that potentially increase the esophageal mucosal damage are: gastric acid, pepsin, bile salts, and pancreatic enzymes. From all of these substances, the highest potential for reflux damage is gastric acid. Although the main cause of clinical symptoms of GERD is acid reflux, it has been known that there are subgroups with typical reflux symptoms that do not provide sufficient response or not responsive to PPI treatment. Despite the improvement of esophagitis, there is no clinical improvements in reflux symptoms of 30% respondents. Therefore, this study was designed to determine fasting gastric acidity with endoscopic findings in patients with GERD. A comparative-analysis study, which determine the fasting gastric acidity from endoscopic findings in patients with GERD. Samples recruited using consecutives sampling technique and divided into groups of esophagitis and non-esophagitis reflux. A total of 40 samples involved in this study. The Mann-Whitney test, was used for analyzing the difference between fasting gastric acidity from endoscopic findings of esophagitis lesions in patient with GERD. The median value for fasting gastric acidity in the esophagitis reflux group was 1.88 (0.82-4.84), whereas the median value for fasting gastric acidity in the non-esophagitis reflux group was 2.49 (0.68-5.97). The Mann-Whitney test result was p=0.298 (p&gt;0.05). This study shows that there is no significant difference of fasting gastric acidity from endoscopic findings between esophagitis and non esophagitis reflux groups in patients with gastroesophageal reflux disease (GERD). This study shows that esophagitis lesions are not affected by gastric acidity

Age and Alarm Symptoms Predict Upper Gastrointestinal Malignancy among Patients with Dyspepsia

Background: Upper gastrointestinal (UGI) malignancy is one of the major causes of cancer related death. Endoscopy in dyspeptic patients above 45 years, or those with alarm symptoms may detect this condition. There were only limited data in Indonesia about age and alarm symptoms to predict UGI malignancy. This study was aimed to determine the prevalence of UGI malignancy among dyspepsia patients and to develop a simple clinical prediction model.Method: A cross-sectional study to 390 patients with dyspepsia underwent endoscopy in Endoscopy Unit of Sanglah Hospital Denpasar between July 2012 and June 2013 was conducted. Demography and alarm symptoms were documented. Chi-square and logistic regression test analysis were conducted to analyze variables associated with UGI malignancy.Results: Twenty (5.13%) of 390 patients with dyspepsia had UGI malignancy. Of the 20 patients, 65% were gastric cancer and 30% were esophageal cancer. The mean age was 59 ± 12 years. Variables associated with UGI malignancy were weight loss (OR = 8.2), dysphagia (OR = 6.2), age > 45 years old (OR = 5.6), gastrointestinal bleeding (OR = 5.5), persistent vomiting (OR = 5.4), and anemia (OR = 4.9). Using a simplified rule of age >45 years and the presence of any alarm symptom, sensitivity was 85% and specificity was 67.57%.Conclusions: UGI malignancy was found in 5.13% of patients with dyspepsia who underwent endoscopy. Simple clinical prediction model states that age above 45 years and alarm symptoms may be used as a screening tool to predict UGI malignancy.Keywords: dyspepsia, alarm symptoms, upper GI malignancy, clinical prediction mode