section name header

Evidence summaries

Diagnostic Value of Alarm Symptoms for Upper Gastrointestinal Malignancy

The risk of upper GI malignancy in any individual without alarm symptoms may be low, but approximately one in four patients with upper GI cancer has no alarm symptoms at the time of diagnosis. Level of evidence: "C"

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.

    References

    • Fransen GA, Janssen MJ, Muris JW, Laheij RJ, Jansen JB. Meta-analysis: the diagnostic value of alarm symptoms for upper gastrointestinal malignancy. Aliment Pharmacol Ther 2004 Nov 15;20(10):1045-52. [PubMed][DARE]

Primary/Secondary Keywords