4910 The yield and predictors of esophageal pathology when upper endoscopy is used to initially evaluate dysphagia: multivariable analysis of 1649 patients.

BACKGROUND: Dysphagia is a common presenting symptom with a wide range of etiologies. The yield and predictors for significant pathology when EGD is used as the initial evaluation is unclear. AIM: Determine the yield and predictive factors of significant pathology when EGD is performed to evaluate dysphagia. METHODS: Data were retrieved from an endoscopic database (GI Trac) of 29,568 EGDs performed at 6 endoscopy units. Patient/procedure data were included in analysis if EGD was performed to evaluate dysphagia. Exclusion criteria were: prior esophageal evaluation including barium swallow or manometry, known upper GI pathology, prior gastroesophageal surgery, and failed EGD. Major pathology was defined as cancer, benign or malignant stricture, Barrett's esophagus, and erosive esophagitis. Multivariable logistic regression was performed to evaluate for any relationship between endoscopic findings and presenting clinical features. RESULTS: Data from 1649 patients with dysphagia (6% of total EGDs) (mean age 56.7 yrs, SD 16.4, M:F 3:2) were analyzed. Symptoms other than dysphagia included: abdominal pain (153), chest pain (44), hematemesis (52), heartburn (302), melena (4), odynophagia(178), vomiting (52), and weight loss (43). Anemia was present in 29 patients. Major pathology was encountered in 727 (44%) patients. Male gender (OR 2.37, p=0.0001), the presence of heartburn (OR 1.68, p=0.0001) and odynophagia (OR 1.63, p=0.003) significantly predicted the presence of major pathology. Cancer was found in 70 (4%) patients and was significantly predicted by male gender (OR 3.5, p=0.0002), age (OR 1.02 p=0.01) and weight loss (OR 2.7, p=0.04). The esophagus was normal in 483 (29%) patients and was predicted by female gender (p=0.0001), the absence of heartburn (p=0.0004) but not age. Other EGD findings included: benign stricture (6%), diverticulum (0.7%), foreign body (3%), hiatal hernia (26%), infection (5%), esophagitis (28%) and esophageal web (10%). CONCLUSIONS: 1] Major pathology is found when EGD is performed to evaluate dysphagia in 44% of patients. 2] Major pathology is more likely in males, and when heartburn or odynophagia are present. 3] EGD is normal in 29% of patients with dysphagia and is more likely in females and if heartburn is absent. Our findings support the use of EGD in the evaluation of dysphagia for structural disease in all age groups, particularly if associated with heartburn, weight loss, or odynophagia.