Digestive Diseases and Sciences

, Volume 63, Issue 12, pp 3442–3447 | Cite as

A Simple Pre-endoscopy Score for Predicting Risk of Malignancy in Patients with Dyspepsia: A 5-Year Prospective Study

  • Amit Kumar DuttaEmail author
  • Grace Rebekah
  • Sudipta Dhar Chowdhury
  • Sajith Kattiparambil Gangadharan
  • Yuvaraj Subramani
  • Manoj Kumar Sahu
  • Reuben Thomas Kurien
  • Deepu David
  • Ebby George Simon
  • Anjilivelil Joseph Joseph
  • Viswanath Reddy Donapati
  • Ashok Chacko
Original Article



The guidelines for performing endoscopy in dyspeptic patients based on clinical parameters alone have shown variable performance, and there is a need for better prediction tools.


We aimed to prospectively develop and validate a simple clinical-cum-laboratory test-based scoring model to identify dyspeptic patients with high risk of upper gastrointestinal malignancy (UGIM).


Adult patients with dyspeptic symptoms were prospectively recruited over 5 years. Clinical details including alarm features were recorded, and blood tests for hemoglobin and albumin were done before endoscopy. The presence of UGIM was the primary outcome. Risk factors for UGIM were assessed, and based on the OR of significant factors, a predictive scoring model was constructed. ROC curve was plotted to identify optimal cutoff score. The model was validated using bootstrapping technique.


The study included 2324 patients (41.9 ± 12.8 years; 33.4% females). UGIM was noted in 6.8% patients. The final model had following five positive predictors for UGIM—age > 40 years (OR 3.3, score 1); albumin ≤ 3.5 g% (OR 3.4, score 1); Hb ≤ 11 g% (OR 3.3, score 1); alarm features (OR 5.98, score 2); recent onset of symptoms (OR 8.7, score 3). ROC curve had an impressive AUC of 0.9 (0.88–0.93), and a score of 2 had 92.5% sensitivity in predicting UGIM. Validation by bootstrapping showed zero bias, which further strengthened our model.


This simple clinical-cum-laboratory test-based model performed very well in identifying dyspeptic patients at risk of UGIM. This can serve as a useful decision-making tool for referral for endoscopy.


Dyspepsia Endoscopy Alarm features Malignancy 



The study was funded by an internal Grant (FLUID Grant) from the parent institute (Christian Medical College, Vellore) (Grant No. 22X 453) where the study was done.

Compliance with ethical standards

Conflict of interest

The authors declare that none of them have any potential conflict of interests.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Amit Kumar Dutta
    • 1
    Email author
  • Grace Rebekah
    • 2
  • Sudipta Dhar Chowdhury
    • 1
  • Sajith Kattiparambil Gangadharan
    • 1
  • Yuvaraj Subramani
    • 3
  • Manoj Kumar Sahu
    • 4
  • Reuben Thomas Kurien
    • 1
  • Deepu David
    • 1
  • Ebby George Simon
    • 1
  • Anjilivelil Joseph Joseph
    • 1
  • Viswanath Reddy Donapati
    • 5
  • Ashok Chacko
    • 6
  1. 1.Department of GastroenterologyChristian Medical College and HospitalVelloreIndia
  2. 2.Department of BiostatisticsChristian Medical CollegeVelloreIndia
  3. 3.Molecular Cardiology Unit, Department of Biochemistry, School of Biological SciencesMadurai Kamaraj UniversityMaduraiIndia
  4. 4.Department of GastroenterologyIMS and SUM HospitalBhubaneswarIndia
  5. 5.Department of GastroenterologyYashoda HospitalSecunderabadIndia
  6. 6.Institute of Gastroenterology and Liver DiseasesThe Madras Medical MissionChennaiIndia

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