Description of the alarm symptoms
qualifying the patient for referral to the Danish Sarcoma Cancer Patient Pathway (CPP) is as follows:
For representativeness of symptoms that from a medical perspective are defined as indicating a serious disease, we selected a number of specific and nonspecific alarm symptoms
covering the following areas: lung, gastrointestinal, gynaecological, and urogenital cancer.
in early diagnosis of cancer in primary care: cohort study using General Practice Research Database.
Once alarm symptoms
have been excluded, the diagnosis of IBS is based upon the presence of characteristic symptoms and changes in stool habits (figure 2 (3,10)).
For this reason we are of the opinion that the urea breath test is suitable for use in testing for the existence of Hp in old patients who have not previously received treatment and who do not have the alarm symptoms
In a comparison of the children who had management changes versus those who did not, there were no significant differences in age, endoscopic findings, PPI use, or the presence of alarm symptoms
. Management changes were made in 41% of the 39 children who had alarm symptoms
and in 59% of the 53 who did not.
These Italian researchers enrolled adults with at least 3 months of typical GERD symptoms and no alarm symptoms
or major comorbidities, who had been referred to a gastroenterologist.
The trend in primary care is toward empiric treatment to control symptoms, and away from a strict diagnosis in patients who have no alarm symptoms
such as hematemesis.
Upper endoscopy is recommended for elderly patients with alarm symptoms
, new-onset GERD, or longstanding disease (SOR: C, expert consensus; see TABLE).
Patients with the onset of dyspepsia at age 56 or older or those with alarm symptoms
(bleeding, anemia, early satiety, unexplained weight loss, dysphagia or odynophagia, persistent vomiting, family history of gastrointestinal malignancy, previous documented peptic ulcer, abdominal mass, or lymphadenopathy) at any age should undergo immediate upper endoscopy.
* Initial endoscopy should be considered for 2 categories of patients: those with alarm symptoms
(eg, dysphagia, odynophagia, bleeding, weight loss, or anemia) and those at higher risk for Barrett's esophagus.
Patients with alarm symptoms
for cancer or bleeding should undergo a thorough diagnostic work-up.