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Dyspepsia is a common gastrointestinal (GI) symptom with 10?20% of the population in the Asia-Pacific region.1 In Western countries, 40?60% of individuals have a normal examination, whilst esophageal or gastric malignancies are detected in less than 1%.2 In Asia, the prevalence of Helicobacter pylori infection and upper GI malignancies are substantially high.3,4 However, among Asian patients with uninvestigated dyspepsia, the diagnostic value of alarm features and the appropriateness of prompt endoscopy are remained uncertainly. Chen et al5 performed a systematic review to evaluate the detection rate of organic diseases including upper GI malignancies and then to propose the proper initial diagnostic strategy in Asian dyspepsia patients. Among 2410 possible references, finally 18 papers (n = 152 314) were included in the analysis of detection of organic disease by endoscopy among dyspeptic patients. This study revealed that overall malignancy detection rate was 1.3% (95% confidence interval 0.8?2.1%) and among cancer patients, 17.8% were younger than 45 years, 5.0% at age < 40 years and 3.0% at age < 35 years. The calculated detection rate of all organic diseases was 26.4% and that of peptic ulcer disease was 11.9% and esophageal disease was 5.5%. However, alarm features were shown to yield moderate diagnostic accuracy with an area under curve of 0.74. It meant limited accuracy for predicting malignancy. Therefore, authors concluded that an age of 35 years yielded relatively better diagnostic accuracy for malignancy.
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