Clinical Scenario
It’s the begining of another night shift in ED. Rik, an agreable young colleague approximates: Hi– he says – I have just seen a 60 y/o man who refers epigastric pain since 2 days. He denies bleeding and weight loss, he isn’t anemic. The bedside US shows a normal gallbladder and a normal abdominal aorta, ECG is OK. It seems an uncomplicated dyspepsia, but he is a 60y/o, I’m worried about a grastric cancer. 
American and European guidelines reccomend gastroscopy for dyspeptic patients older than 45 or 55 yr of age (depending on local incidence of gastric cancer). The incidence of gastric cancer in uncomplicated dyspepsia is very low, <1% in Western Europe, and < 3% in North of America.
Specific age cut-off alone, in a patient with an uncomplicated dyspepsia has a poor prediction power. The percentage of patients with neoplasia increases with age but there’s also a little percentage of patients younger of 45 yr suffering from a gastric cancer.
Based on this conclusion, shall we prescribe a gastroscopy for all dyspeptic patients?
  To be continued…


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