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ORIGINAL ARTICLE
Year : 2014  |  Volume : 2  |  Issue : 2  |  Page : 52-55

Incidence of gastric carcinoma in patients presenting with dyspepsia in tertiary care hospital


1 Department of General Surgery, Father Muller Medical College Hospital, Kankanady, Mangalore, Karnataka, India
2 Department of Surgery, Father Muller Medical College Hospital, Kankanady, Mangalore, Karnataka, India
3 Department of Pathology, Father Muller Medical College Hospital, Kankanady, Mangalore, Karnataka, India
4 Department of Gastroenterology, Father Muller Medical College Hospital, Kankanady, Mangalore, Karnataka, India

Date of Web Publication12-Sep-2014

Correspondence Address:
Prathvi Shetty
Department of General Surgery, Father Muller Medical College Hospital, Kankanady, Mangalore - 575 002, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2320-3846.140693

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  Abstract 

Context: Gastric carcinoma often present with nonspecific gastrointestinal symptoms like dyspepsia making its diagnosis difficult and its later detection in an advance stage. To reduce the mortality and morbidity early diagnosis of gastric carcinoma is of utmost importance. Aims: The aim was to detect gastric carcinoma in patients presenting with dyspepsia symptoms for upper gastrointestinal (UGI) endoscopy and to study the incidence of carcinoma stomach related to factors like age, alcohol and smoking. Design: Surveillance cross section study. Subjects and Methods: Data were collected in all clinically diagnosed cases of dyspepsia undergoing UGI endoscopy at Father Muller Medical College Hospital, with sample size of 119 patients. Multiple (6-8) biopsies from suspected lesions were taken and sent for histopathological examination. Statistical Analysis Used: Frequency, percentage, Chi-square test and Fischer's exact test. Results: Of the 119 patients subjected to UGI endoscopy, 13 (10.9%) of them had gastric carcinoma. Mean age of the patient in the study was 49.76. Majority of the patients were males 58.82% (n - 70) and females were 41.17% (n - 49). Gastric carcinoma was predominantly seen in males - 76% and females - 24%. Alarm symptoms were found present in 53.84% with gastric carcinoma. Gastric carcinoma had strong association with smoking 38.46%, but not significant with alcohol consumption and showed peaking in incidence in the fifth and sixth decade. Conclusions: A high index of suspicion by clinicians and availability of endoscopic facilities may help detect early lesions, especially in elderly patients with alarm symptoms.

Keywords: Acid peptic disease, alarm symptoms, dyspepsia, gastric cancer, stomach cancer, upper gastrointestinal endoscopy


How to cite this article:
Shetty P, Muktar L, Devaraju S, Vittal R. Incidence of gastric carcinoma in patients presenting with dyspepsia in tertiary care hospital . Saudi Surg J 2014;2:52-5

How to cite this URL:
Shetty P, Muktar L, Devaraju S, Vittal R. Incidence of gastric carcinoma in patients presenting with dyspepsia in tertiary care hospital . Saudi Surg J [serial online] 2014 [cited 2022 Dec 3];2:52-5. Available from: https://www.saudisurgj.org/text.asp?2014/2/2/52/140693


  Introduction Top


Early diagnosis of gastric carcinoma has evaded surgeons mostly due to nonspecific upper gastrointestinal (UGI) symptom like dyspepsia. Most of them go undiagnosed in the early stages and later present with advanced disease. [1] Early gastric cancer is defined as a gastric carcinoma confined to the mucosa or submucosa regardless of lymph node status and it has an excellent prognosis with a 5-year survival rate. [2] Hence, detecting gastric cancer at an early stage is of paramount importance to reduce the mortality and the morbidity. [3]

Dyspepsia is a presenting symptom of duodenal ulcer, gastric ulcer, nonulcer dyspepsia, gastroesophageal reflux and gastric carcinoma. [4] More than 50% of the dyspeptic patients are under the age of 45-year but if present with "alarm" symptoms (anemia, mass, dysphagia, weight loss, vomiting), a high index of suspicion should be kept. [5]

To evaluate dyspepsia, endoscopy is considered gold standard investigation. It is the discretion of the treating doctor or indicated for those patients with persisting dyspeptic symptoms. As early gastric carcinoma and peptic ulcer disease both share similar patho physiology, subjecting patients with dyspepsia for UGI endoscopy gains importance. [6]

This study was conducted in our hospital to know the incidence of gastric carcinoma by subjecting the patients presenting with history of dyspepsia disease to UGI endoscopy.

Aims and objectives

  • To detect gastric carcinoma in patients presenting with dyspepsia symptoms for UGI endoscopy
  • To study the incidence of carcinoma stomach related to factors like age, sex, alcohol and smoking.



  Subjects and Methods Top


Data were collected in all clinically diagnosed cases of dyspepsia - patients coming with complains of abdominal distension/fullness, bloating, nausea, heart burn, and vague upper abdominal pain. These patients underwent UGI endoscopy at our hospital. A written informed consent was obtained from each patient enrolled in this study. A brief history and clinical examination was carried out in every patient. Consent for UGI endoscopy was taken and then the procedure carried out. Multiple (6-8) biopsies from suspected lesions were taken and sent for histopathological examination.

Study design

Surveillance cross section study.

Method of sampling

  • Sample size: 119.


Inclusion criteria

  • Patients attending our hospital with the complaints of dyspepsia symptoms
  • Both sexes above the age of 25-year.


Exclusion criteria

  • Age <25 years
  • Advance gastric carcinoma.


Data analysis

The data collected were analyzed using frequency, percentage, Chi-square test and Fischer's exact test.


  Results Top


In our study, 119 patients (n = 119) who presented with dyspepsia were taken up and subjected to UGI endoscopy. Mean age of the patient was 49.76 years. Majority of the patients were males 58.82% (n - 70) and females 41.17% (n - 49).

Thirteen of 119 (10.9%) were found to have gastric carcinoma [Figure 1], 7 in stage 1B, 3 in stage 2A, 2 in stage 2B and one in stage 3A. The duration of dyspepsia in these 13 patients ranged from 6 to 18 months. Predominance of males with gastric carcinoma was seen in our study male -76% and female - 24% [Figure 2]. Most of the patients belong to the age group 51-65 (61.53%), >65 (23.07%), 20-35 (7.6%), 36-51 (7.6%) [Figure 3]. Among 10.9% who were positive for gastric carcinoma 53.84% had associated alarm symptoms. In our study, 38.46% (5/13) of those who had gastric carcinoma had strong association with smoking [Figure 4] were as alcohol did not show any association with carcinoma stomach.
Figure 1: Pie chart of percentage of gastric cancer in the sample population

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Figure 2: Male: Female ratio of presence of gastric malignancy

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Figure 3: Bar diagram of age versus total patients versus carcinoma of the stomach

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Figure 4: Pie chart of smokers versus nonsmokers with gastric carcinoma

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  Discussion Top


Carcinoma of the stomach is still the second most common cause of cancer death worldwide. Though in geographical variation India is at low risk, it was found to be one of the leading causes of death in Southern India. [7]

The time lag between the appearance of symptoms and the onset of initiation of gastric growth leads to the difficulty in diagnosing it at an early stage. Vague gastrointestinal symptoms and nonspecific presentation of gastric carcinoma that are indistinguishable from benign peptic ulcer disease makes their diagnosis difficult and for their late presentation. Lack of mass screening and poor endoscopy facilities also leads to frequent miss of gastric carcinoma in developing countries. [8]

Gastric carcinomas are predominately found in male with incidence peaking up during the fifth decade; similar results have been shown in our study too. This finding corroborates with finding of Hajmanoochehri et al. who in their hospital based retrospective study of 20-year showed male patients had a large predominance (sex ratio = 2.33/1) and presenting at sixth decade. [9]

Diet and lifestyle also playing an important role and is a high risk factor for gastric carcinoma. Vegetables and fruits are found to be protective factors, while pickled food, high rice intake, spicy salty food, consumption of high-temperature foods, smoked dried salted meat or fish, have been shown to have significant dietary risk factors. Collaborating with other studies most of our patients were consuming diet rich in vegetables, pulses and less of red meat hence the probability of incidence of gastric carcinoma has been seen less in our and other Indian studies compared with the high risk population where the consumption of meat, high nitrates and smoked food is more. [10] Wong and Lam showed in their study that food and nutritional factors play a major role in gastric carcinogenesis. Although fruit and vegetables have an inverse relationship with gastric malignancy, intake of salted food increases the incidence. [11]

In our study, 38.46% of those who had gastric carcinoma had strong association with smoking in sync with other studies. [12] Koizumi et al. examined the association between cigarette smoking and the risk of gastric cancer in their prospective cohort studies. They found the higher number of cigarettes smoked per day was associated with a linear increase in risk and also significant increase in risk for past smokers remained for up to 14-year after cessation. [13]

Alcohol did not show any association with carcinoma stomach in our study. This is comparable to others who also failed to show any association between them. [14] The meta-analysis was performed by Tramacere et al. proves there is absence of association between alcohol drinking and gastric adenocarcinoma risk, even at higher doses of consumption. [15]

Most of the patients with UGI cancer do present with alarm symptoms and chances of them being in the advance stage is more. Maconi et al. have shown in their study that the risk of death is nearly threefold in patients with at least one alarm symptom compared with that in patients with uncomplicated dyspepsia. [16] Bowrey et al. had reported that the patients with "alarm" symptoms had a significantly more advanced tumor stage were less likely to undergo surgical resection (50% vs. 95%), and poorer survival rate (median, 11 vs. 39 months) than their counterparts without such symptoms. [5] Among 10.9% who were positive for gastric carcinoma in our study, 53.84% had associated alarm symptoms. Weight loss and anemia were significant alarm symptoms found in our study [Figure 5]. This validates the point that dyspeptic patients with alarm symptoms need to be scoped when empirical treatment does not relieve the symptoms.
Figure 5: Alarm symptoms with related number of cancer positive

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Health education for patients and making UGI endoscopy a standard screening investigation for patients above the age of 50-year with dyspeptic symptoms will take a step forward in the early detection of gastric cancer.


  Conclusion Top


Early detection of gastric carcinoma decreases mortality and morbidity hence surveillance with endoscopy becomes an important tool. The diagnosis of early gastric carcinoma is infrequently done here due to its low prevalence, which means the endoscopists do not look for it conscientiously as they would do in a high prevalent area. Early curable cancers often presents as dyspeptic symptoms and their diagnosis delayed if the clinician does not have a high index of suspicion, this is further made difficult with wide use of proton pump inhibitor, which tends to mask the symptoms. Mass screening is not cost-effective; hence, it is recommended clinicians in low risk population should have lower threshold to scope the patient who have high risk history, patients, especially males above the age of 50-year presenting with dyspeptic symptoms not reduced by empirical treatment and patients presenting with alarm symptoms. Screening for this group of patients will improve early detection and thus the prognosis of gastric cancer.

 
  References Top

1.Breslin NP, Thomson AB, Bailey RJ, Blustein PK, Meddings J, Lalor E, et al. Gastric cancer and other endoscopic diagnoses in patients with benign dyspepsia. Gut 2000;46:93-7.  Back to cited text no. 1
    
2.Yokota T, Kunii Y, Teshima S, Yamada Y, Saito T, Takahashi M, et al. Significant prognostic factors in patients with early gastric cancer. Int Surg 2000-Dec; 85:286-90.  Back to cited text no. 2
    
3.Marchet A, Mocellin S, Ambrosi A, Morgagni P, Vittimberga G, Roviello F, et al. Validation of the new AJCC TNM staging system for gastric cancer in a large cohort of patients (n=2,155): Focus on the T category. Eur J Surg Oncol 2011;37:779-85.  Back to cited text no. 3
    
4.Canga C rd, Vakil N. Upper GI malignancy, uncomplicated dyspepsia, and the age threshold for early endoscopy. Am J Gastroenterol 2002;97:600-3.  Back to cited text no. 4
    
5.Bowrey DJ, Griffin SM, Wayman J, Karat D, Hayes N, Raimes SA. Use of alarm symptoms to select dyspeptics for endoscopy causes patients with curable esophagogastric cancer to be overlooked. Surg Endosc 2006;20:1725-8.  Back to cited text no. 5
    
6.Tan YK, Fielding JW. Early diagnosis of early gastric cancer. Eur J Gastroenterol Hepatol 2006;18:821-9.  Back to cited text no. 6
    
7.Dikshit RP, Mathur G, Mhatre S, Yeole BB. Epidemiological review of gastric cancer in India. Indian J Med Paediatr Oncol 2011;32:3-11.  Back to cited text no. 7
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8.Mabula JB, Mchembe MD, Mheta K, Chalya PL, Massaga F. Gastric cancer at a university teaching hospital in northwestern Tanzania: A retrospective review of 232 cases. World J Surg Oncol 2012;10:257.  Back to cited text no. 8
    
9.Hajmanoochehri F, Mohammadi N, Nasirian N, Hosseinkhani M. Patho-epidemiological features of esophageal and gastric cancers in an endemic region: A 20-year retrospective study. Asian Pac J Cancer Prev 2013;14:3491-7.  Back to cited text no. 9
    
10.Ramón JM, Serra L, Cerdó C, Oromí MJ. Dietary factors and gastric cancer risk. A case-control study in Spain. Cancer 1993;17:1731-5.  Back to cited text no. 10
    
11.Wong BC, Lam SK. Diet and gastric cancer. GI Cancer 1998;3:1-10.  Back to cited text no. 11
    
12.Karthick P, Chidambaram K, Sowmya T, Natarajan R. Incidence of stomach carcinoma in patients with acid peptic disease in rural hospital. Internet J Health 2012;1.  Back to cited text no. 12
    
13.Koizumi Y, Tsubono Y, Nakaya N, Kuriyama S, Shibuya D, Matsuoka H, et al. Cigarette smoking and the risk of gastric cancer: A pooled analysis of two prospective studies in Japan. Int J Cancer 2004;112:1049-55.  Back to cited text no. 13
    
14.Lindblad M, Rodríguez LA, Lagergren J. Body mass, tobacco and alcohol and risk of esophageal, gastric cardia, and gastric non-cardia adenocarcinoma among men and women in a nested case-control study. Cancer Causes Control 2005;16:285-94.  Back to cited text no. 14
    
15.Tramacere I, Pelucchi C, Bagnardi V, Rota M, Scotti L, Islami F, et al. A meta-analysis on alcohol drinking and esophageal and gastric cardia adenocarcinoma risk. Ann Oncol 2012;23:287-97.  Back to cited text no. 15
    
16.Maconi G, Kurihara H, Panizzo V, Russo A, Cristaldi M, Marrelli D, et al. Gastric cancer in young patients with no alarm symptoms: Focus on delay in diagnosis, stage of neoplasm and survival. Scand J Gastroenterol 2003;38:1249-55.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]


This article has been cited by
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[Pubmed] | [DOI]



 

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