Upper gastrointestinal endoscopy findings in adults with dyspepsia younger than 60 years in Lagos, Nigeria

Background and Objectives: Recent guidelines from international gastroenterology bodies recommend that upper gastrointestinal endoscopy (UGIE) should not be routinely performed in patients with dyspepsia who are younger than 60 years old as the yield for major abnormalities is low. The objectives of this study were to determine the spectrum of UGIE findings in patients with dyspepsia who are younger than 60 years and to document the association of alarm features with UGIE findings in them. Materials and Methods: This is a retrospective study of the UGIE records of adult patients younger than 60 years with dyspepsia at five centers in Lagos, Nigeria, between June 2016 and December 2020. UGIE findings were categorized as major (gastric or duodenal ulcers, esophageal varices, masses suspected to be cancer, strictures, and foreign bodies), minor (erosions or inflammation), or normal. Results: There were 1499 adult patients with dyspepsia who were younger than 60 years, 796 (53.1%) females, mean age 40.9 ± 9.8 years, and 158 (10.5%) with at least one alarm feature. Major findings were seen in 194 (12.9%), minor findings in 1023 (68.2%), and no abnormalities were seen in 282 (18.8%). Alarm features, or age 40 years and above, were associated with major findings. Half of all gastric cancers were seen in patients younger than 50 years, and of these, 70% occurred within the 40–49 age group. Conclusion: This study shows that the prevalence of UGIE findings in patients with dyspepsia who are younger than 60 years is high, and major findings are common in those with alarm features or who are aged 40 years and above. We recommend endoscopy for the evaluation of dyspepsia in those who have alarm features or are aged at least 40 years.