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Review: alarm features in dyspepsia do not have high diagnostic accuracy for predicting upper gastrointestinal cancer

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 Q In patients with dyspepsia, what is the accuracy of alarm features (eg, dysphagia, weight loss, or anaemia) for detecting upper gastrointestinal (GI) cancer?

Clinical impact ratings GP/FP/Primary care ★★★★★☆☆ IM/Ambulatory care ★★★★★★☆ Gastroenterology ★★★★★★☆


Embedded ImageData sources:

Medline (1966–2003), CINAHL (1982 to Jan 2005), EMBASE/Excerpta Medica (1988 to Jan 2005), and Cochrane Controlled Trials Register (Jan 2005).

Embedded ImageStudy selection and assessment:

prospective studies that evaluated dyspepsia and alarm symptoms in unselected adults (>16 y of age), included >100 patients, compared symptoms with endoscopic diagnosis, and diagnosed >1 upper GI cancer. Studies were pooled using a random effects model. Study quality was assessed. 18 studies met the selection criteria.

Embedded ImageOutcomes:

sensitivity, specificity, and likelihood ratios.


Pooled estimates showed that clinical …

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  • For correspondence: Dr N Vakil, University of Wisconsin Medical School, Milwaukee, WI, USA. nvakil{at}

  • Source of funding: not stated.