Limited Value of Alarm Features in the Diagnosis of Upper Gastrointestinal Malignancy: Systematic Review and Meta-analysis

Nimish Vakil, Paul Moayyedi, M (Brian) Fennerty, Nicholas J. Talley

Research output: Contribution to journalArticle

136 Citations (Scopus)

Abstract

Background & Aims: Alarm features such as dysphagia, weight loss, or anemia raise concern of an upper gastrointestinal malignancy in patients with dyspepsia. The aim of this study was to determine the diagnostic accuracy of alarm features in predicting malignancy by performing a metaanalysis based on the published literature. Methods: English-language studies were identified by searching MEDLINE, EMBASE, Cochrane Controlled Trials Register, and CINAHL. Cohort studies that measured alarm features and compared them with the endoscopic findings were included. Studies were screened for inclusion by 2 authors who independently extracted the data. Sensitivity, specificity, and likelihood ratios were calculated by comparing the alarm feature with the endoscopic diagnosis. The summary receiver operating characteristic curve method was used to summarize test characteristics across studies. Individual alarm features were also assessed when the study report permitted. Results: Eighty-three of 2600 studies met the initial screening criteria; 15 met inclusion criteria after detailed review. These 15 studies evaluated a total of 57,363 patients, of whom 458 (.8%) had cancer. The sensitivity of alarm symptoms varied from 0% to 83% with considerable heterogeneity between studies. The specificity also varied significantly from 40% to 98%. A clinical diagnosis made by a physician was very specific (range, 97%-98%) but not very sensitive (range, 11%-53%). Conclusions: Alarm features have limited predictive value for an underlying malignancy. Their use in dyspepsia management strategies needs further refinement and study.

Original languageEnglish (US)
Pages (from-to)390-401
Number of pages12
JournalGastroenterology
Volume131
Issue number2
DOIs
StatePublished - Aug 2006

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Meta-Analysis
Dyspepsia
Neoplasms
Deglutition Disorders
MEDLINE
ROC Curve
Anemia
Weight Loss
Cohort Studies
Language
Physicians
Sensitivity and Specificity

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Limited Value of Alarm Features in the Diagnosis of Upper Gastrointestinal Malignancy : Systematic Review and Meta-analysis. / Vakil, Nimish; Moayyedi, Paul; Fennerty, M (Brian); Talley, Nicholas J.

In: Gastroenterology, Vol. 131, No. 2, 08.2006, p. 390-401.

Research output: Contribution to journalArticle

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