教員業績データベース |
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論文種別 | 原著 |
言語種別 | 英語 |
査読の有無 | 査読なし |
表題 | Systematic review with meta-analysis: prompt endoscopy as the initial management strategy for uninvestigated dyspepsia in Asia. |
掲載誌名 | 正式名:Alimentary pharmacology&therapeutics 略 称:Aliment Pharmacol Ther ISSNコード:1365-2036(Electronic)0269-2813(Linking) |
巻・号・頁 | 41(3),pp.239-52 |
著者・共著者 | Chen S L, Gwee K A, Lee J S, Miwa H, Suzuki H, Guo P, Hao Y T, Chen M H |
発行年月 | 2014/11 |
概要 | BACKGROUND:Prompt endoscopy should be considered as an initial strategy for uninvestigated dyspepsia in the background of high prevalence of Helicobacter pylori infection and malignancy. However, with changes of disease patterns and dyspepsia definition, the prevalence of organic lesions at endoscopy in dyspepsia patients and the predictive values of alarm features and age for in malignancy remain unclear in Asian population.AIMS:To evaluate the appropriateness of prompt endoscopy as an initial dyspepsia management strategy, we investigated the organic lesion detection rates in Asian dyspepsia patients as well as the diagnostic accuracies of alarm features and age thresholds for malignancy.METHODS:Literature was retrieved from MEDLINE, PubMed, Embase, Cochrane Library and CINAHL Plus. The prevalence rates of organic lesions and young cancer patients among dyspeptic patients and the sensitivities, specificities, likelihood ratios and diagnostic odds ratio (DOR) of alarm features and ages were estimated. The summary receiver operating characteristic curve was constructed and the area under the curve (AUC) calculated. Subgroup, sensitivity and meta-regression analyses were performed.RESULTS:Of the 18 included studies, 15 reported organic lesion detection rates, and six and five analysed the predictive values of alarm features and ages respectively. The overall malignancy detection rate was 1.3% (95% CI: 0.80-2.10). Among cancer patients, 17.8% (95% CI: 10.90-29.00) were younger than 45 years and 3.0% (95% CI: 2.50-3.50) were younger than 35 years. The diagnostic accuracy of alarm features for predicting malignancy was moderate (DOR: 4.87, 95% CRESULTS:I: 2.72-8.71; AUC = 0.74). The diagnostic accuracy at ageRESULTS:>RESULTS:35 years (DOR: 9.41, 95% CI: 7.89-11.21; AUC = 0.82) was better than that at ageRESULTS:>RESULTS:45 years (DOR: 3.50, 95% CI: 2.32-5.27; AUC = 0.70).CONCLUSIONS:The malignancy detection rate and proportion of young cancer patients were high among As |
DOI | 10.1111/apt.13028 |
PMID | 25429769 |