The role of alarm symptoms in the diagnosis of upper gastrointestinal system malignancies

The Role of Alarm Symptoms in the Diagnosis of Upper Gastrointestinal System Malignancies Aim: Studies have reported increased malignancy rates in patients with alarm symptoms compared to the normal population. The presence of alarm symptoms is considered a reason to refer patients for upper gastrointestinal (GI) endoscopy. In our study, we aimed to investigate the diagnostic value of alarm symptoms in the diagnosis of upper GIS malignancy. Material and Methods: Patients who applied to Karadeniz Technical University Faculty of Medicine Gastroenterology and Internal Diseases Polyclinic between 01.01.2020 - 01.01.2021 and had alarm symptoms for upper GIS cancers were included in our study. Patients under the age of 18 and over the age of 80 were excluded from the study. Demographic characteristics of the patients, complaints at presentation, alarm symptoms, endoscopy and pathology results were evaluated prospectively. Results: A total of 325 patients were included in the study. The mean age at the time of admission was 50,8 ± 15,8 years, %62,5 of the patients were female and %37,5 were male. The most common complaints were dyspepsia %80), nausea (%25,8) and abdominal pain (%23,1), respectively. The most common alarm symptoms were dyspepsia which started over the age of 45 (%48,6), weight loss (%34,8) and iron deficiency anemia (%31,1), respectively. In our study, 8 patients (%2,5) were diagnosed with malignancy. All patients diagnosed with malignancy were over the age of 45. The mean age in the malignant patient group (62,75 ± 10,45) was statistically significantly higher than the patients without malignancy (50,47 ± 15,82) (p=0.03). Of the patients with malignancy, 7 were male and 1 was female, and the incidence of malignancy was statistically significantly higher in male patients than in female patients (p=0,005). The 3 alarm symptoms with the highest sensitivity in the diagnosis of malignancy; weight loss (%75), iron deficiency anemia (%50), progressive dysphagia/odynophagia (%37,5), and dyspepsia over 45 years of age (%37,5). The 3 most specific alarm symptoms were palpablev abdominal/epigastric mass or abnormal lymphadenopathy (%96,5), upper gastrointestinal bleeding (%96,2), and persistent vomiting (%92,4). Conclusion: Our study showed that alarm symptoms are not effective enough in the diagnosis of upper GI cancers. Advanced age and male gender were found to be at high risk for malignancy in patients with alarm symptoms. Alarm symptoms alone are not sufficient in the diagnosis of upper GI cancers; its should be combined with physical examination and laboratory results. Large case series are needed on the efficacy of alarm symptoms in diagnosis. Keywords: Alarm symptoms, malignancy, upper gastrointestinal tract, endoscopy