Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2020; 26(30): 4523-4536
Published online Aug 14, 2020. doi: 10.3748/wjg.v26.i30.4523
Predictive value of alarm symptoms in patients with Rome IV dyspepsia: A cross-sectional study
Zhong-Cao Wei, Qian Yang, Qi Yang, Juan Yang, Xin-Xing Tantai, Xin Xing, Cai-Lan Xiao, Yang-Lin Pan, Jin-Hai Wang, Na Liu
Zhong-Cao Wei, Qian Yang, Xin-Xing Tantai, Xin Xing, Cai-Lan Xiao, Jin-Hai Wang, Na Liu, Department of Gastroenterology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
Qi Yang, Juan Yang, Department of Gastroenterology, Xi’an No. 3 Hospital, the Affiliated Hospital of Northwest University, Xi’an 710018, Shaanxi Province, China
Yang-Lin Pan, State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi’an 710032, Shaanxi Province, China
Author contributions: Wei Z-C, Pan Y-L, Wang J-H and Liu N designed the research; Wei Z-C, Yang Q, Yang Q and Yang J performed the research; Tantai X-X, Xing X and Xiao C-L contributed analytic tools; Wei Z-C and Yang Q analyzed the data; Wei Z-C, Pan Y-L, Wang J-H and Liu N wrote the paper.
Institutional review board statement: The study was approved by the ethics committee of the Second Affiliated Hospital of Xi’an Jiaotong University.
Informed consent statement: Verbal informed consent was obtained from all participants.
Conflict-of-interest statement: There is no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The guidelines of the STROBE statement have been adopted in preparing the manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Na Liu, PhD, Doctor, Division of Gastroenterology, The Second Affiliated Hospital, Xi’an Jiaotong University, No. 157 Xiwu Road, Xi’an 710004, Shaanxi Province, China. liunafmmu@163.com
Received: April 20, 2020
Peer-review started: April 20, 2020
First decision: May 15, 2020
Revised: May 26, 2020
Accepted: July 23, 2020
Article in press: July 23, 2020
Published online: August 14, 2020
Abstract
BACKGROUND

No studies have evaluated the predictive value of alarm symptoms for organic dyspepsia and organic upper gastrointestinal (GI) diseases based on Rome IV criteria in the Chinese population.

AIM

To evaluate the predictive value of alarm symptoms for dyspeptic patients based on Rome IV criteria.

METHODS

We performed a cross-sectional study of dyspepsia patients who met the inclusion and exclusion criteria at two academic urban tertiary-care centers from March 2018 to January 2019. Basic demographic data, dyspeptic information, alarm symptoms, lifestyle, examination results, family history and outpatient cost information were collected. Dyspepsia patients with normal findings on upper GI endoscopy, epigastric ultrasound and laboratory examination and without Helicobacter pylori-associated dyspepsia were classified as functional dyspepsia.

RESULTS

A total of 381 patients were enrolled in the study, including 266 functional dyspepsia patients and 115 organic dyspepsia patients. There were 24 patients with organic upper GI disease among patients with organic dyspepsia. We found that based on the Rome IV criteria, alarm symptoms were of limited value in differentiating organic dyspepsia and organic upper GI diseases from functional dyspepsia. Age (odds ratio (OR) = 1.056, P = 0.012), smoking (OR = 4.714, P = 0.006) and anemia (OR = 88.270, P < 0.001) were independent predictors for organic upper GI diseases. For the comparison of epigastric pain syndrome, postprandial distress syndrome and epigastric pain syndrome combined with postprandial distress syndrome, the results showed that there were statistically significant differences in anorexia (P = 0.021) and previous visits (P = 0.012). The ClinicalTrials.gov number is NCT 03479528.

CONCLUSION

Most alarm symptoms had poor predictive value for organic dyspepsia and organic upper GI diseases based on Rome IV criteria. Gastroscopic screening should not be based solely on alarm symptoms.

Keywords: Rome IV, Dyspepsia, Alarm symptoms, Prediction

Core tip: Dyspepsia is a symptom complex referable to the upper gastrointestinal tract. Based on the Rome IV criteria, alarm symptoms were of limited value in differentiating organic dyspepsia and organic upper gastrointestinal diseases from functional dyspepsia, and gastroscopic screening should not be based solely on alarm symptoms. Age, smoking and anemia were the independent predictors for organic upper gastrointestinal diseases. The clinical characteristics of patients with epigastric pain syndrome, postprandial distress syndrome and the two combined were not significantly different.