Choice of age cut-off for endoscopy in dyspepsia in developing countries according to incidence of gastric cancer.

Endoscopic examination of all patients with dyspepsia is hard to perform, because of high annual prevalence of dyspepsia and limited resource availability, especially in developing countries. Aim was to establish age cut off for upper endoscopy in dyspeptic patients without alarming features according on incidence of gastric cancer in western Herzegovina in Bosnia and Herzegovina. Group of 2697 (1536 males, 1161 females) patients over 15 with chronic dyspepsia without alarming features and symptoms of gastroesophageal reflux disease, had been referred for a diagnostic upper endoscopy during 4 years. Study was prospective. All 34 gastric cancers were diagnosed in male patients above 55 years, and in female ones above 60. In the same age groups two thirds of gastric ulcers were found out. If the age cut off for dyspeptic patients had been 55 years for male and 60 for female gender, the workload could be decreased by 50%. The choice of alternative approaches is possible, depending on the level of diagnostic uncertainty, the patient and his physician are prepared to accept. Age cut off determines diagnostic approach in chronic dyspepsia, and greatly decreases the endoscopy workload.