A systematic review 1 including 9 cohort studies (16,161 participants) and 17 case studies (1,552 participants) was abstracted in DARE. Case studies. The pooled sensitivities for the individual alarm symptoms were: dysphagia, 40% (95% confidence interval, CI: 36 to 43; 5 studies), anaemia or bleeding, 27% (95% CI: 24 to 31; 4 studies), nausea or vomiting, 21% (95% CI: 18 to 25; 11 studies); weight loss, 41% (95% CI: 37 to 44; 15 studies). For 'any alarm symptom', the sensitivity was 94% (95% CI: 92 to 96; 11 studies). Cohort studies. The mean prevalence of upper GI malignancy was 2.8%. Pooled sensitivities and specificities for the individual alarm symptoms were: dysphagia, sensitivity 25% (95% CI: 17 to 23; 3 studies) and specificity 94% (95% CI: 93 to 94); anaemia or bleeding, sensitivity 17% (95% CI: 12 to 23; 4 studies) and specificity 90% (95% CI: 89 to 90); nausea or vomiting, sensitivity 27% (95% CI: 18 to 35; 2 studies) and specificity 78% (95% CI: 76 to 80); weight loss, sensitivity 24% (95% CI: 18 to 30; 5 studies) and specificity 93% (95% CI: 92 to 93). For 'any alarm symptom', the pooled sensitivity was 75% (95% CI: 67 to 82; 5 studies) and the pooled specificity was 79% (95% CI: 78 to 80).
Comment: The quality of evidence is downgraded by poor methodology of the review and original studies.
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