Diagnostic Yield of Upper Endoscopy in Young Patients with Dysphagia

Introduction: Dysphagia is considered an alarm symptom, indicating the need for upper endoscopy. However, the cost of upper endoscopy is high and the procedure is not well tolerated especially by young patients. Moreover, the diagnostic yield of upper endoscopy in young patients with dysphagia remains uncertain. Aim: To assess the diagnostic yield of upper endoscopy in patients under 50 years of age with dysphagia. Material and Methods: Upper endoscopy was performed in all consecutive patients with dysphagia referred to our center over a 4 year period. We assesed the prevalence of upper endoscopy findings in young patients (aged ≤ 50 years) and in older patients (> 50 years). We defined as positive findings those that could potentially cause dysphagia and required specific treatment: neoplasic lesions of esophagus or gastroesophageal junction, strictures, rings or webs, esophageal diverticula, esophagitis (erosive esophagitis grade C or D, eosinophilic esophagitis, infectious esophagitis) and ulcer of esophagus or gastroesophageal junction. Results: Five hundred patients with dysphagia (male 219 (44%), median age 67, range 18-97) were included. Sixty nine patients (male 40 (58%), median age 41) were ≤ 50 years of age, and 431 patients (male 182 (42%), median age 71) were > 50 years of age. There was a preponderance in male gender in patients ≤ 50 years (p= 0.018). Positive findings were found in 17/69 (25%) patients aged ≤ 50 years and in 136/431 (32%) patients aged >50 years (p = 0.31). Esophageal cancer was found in 2/69 (3%) patients aged ≤ 50 years and in 30/431 (7%) patients aged >50 years (p = 0.29). Other positive findings in under 50-year-old patients were: erosive esophagitis grade C or D (8 patients), strictures (3 patients), candida esophagitis (2 patients), rings (1 patient), esophagus ulcer (1 patient). Conclusion: In this study, a quarter of the young patients presenting with dysphagia had a lesion detected by upper endoscopy that could be treated. Therefore, these results agree with the need of performing upper endoscopy in young patients presenting with dysphagia.