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Research Article | DOI: https://doi.org/10.31579/2690-1919/441
1Junior Resident, Department of General Surgery, RNT Medical College, Udaipur, Rajasthan, India.
2Department of General Surgery, RNT Medical College, Udaipur, Rajasthan, India.
*Corresponding Author: Poulomi Mahapatra., Department of General Surgery, RNT Medical College, Udaipur, Rajasthan, India.
Citation: Poulomi Mahapatra, Siddhartha Verma, Atul Ameta, Pulkit Agarwal, (2025), Upper Gastrointestinal Disease Symptoms and Endoscopic Findings – A Comparative Analysis, J Clinical Research and Reports, 18(4); DOI:10.31579/2690-1919/441
Copyright: © 2025, Poulomi Mahapatra. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 15 January 2025 | Accepted: 03 February 2025 | Published: 17 February 2025
Keywords: general surgery; hiatal hernia; gastrointestinal surgery
This will improve the early detection and treatment of upper digestive tract diseases and improve the quality of care provided. The development of similar research in different geographic regions with different methodological approaches will enable full comprehension of the topic. Limitations, such as obtaining study sample from a single centre and lack of follow-up of the study's participants were noted. Our evaluation relied on self-reporting. Finally, recall bias may have occurred because symptoms were investigated that occurred within the past
Digestive symptoms are among the most common complaints from patients who seek primary healthcare services. Dyspepsia, defined as pain or recurrent discomfort in the upper abdomen, is one of the most common symptoms of gastrointestinal disease. It includes several symptoms, epigastric pain, retrosternal pain or heartburn, post prandial fullness and regurgitation, atypical symptoms being hoarseness, dysphagia & vomiting. [1,2].
Symptoms can be associated with different gastrointestinal diseases such as esophagitis, gastritis, peptic ulcer, and gastric cancer, which are the main causes of gastrointestinal morbidity and mortality worldwide.[3]. Western endoscopy societies, [4,5]. as well as Asian recommendations, [6]. recommend investigation of these symptoms through upper gastrointestinal endoscopy, also known as esophagogastroduodenoscopy (EGD) to detect organic diseases that cause the patient's symptoms and to exclude malignancies.
EGD is the most common endoscopic procedures used for the investigation of digestive symptoms and provides information for the diagnosis and treatment of gastrointestinal disorders. [5,7]. The indications for EGD include patients aged above 40 years with warning signs (symptoms of dysphagia, unintentional weight loss, odynophagia, anaemia, digestive tract haemorrhage, nausea, persistent vomiting, or family history of cancer). It is recommended to conduct EGD immediately in the presence of warning signs. [8].
EGD has proven to be a relatively safe procedure that can be performed in large healthcare centres, small rural hospitals or even private practices. Socioeconomic factors, lifestyle habits, diet, genetic and environmental factors, infectious diseases are involved in the appearance of symptoms which can vary throughout the world. [10]. Consequently, the timely performance of EGD to investigate the patient's symptoms leads to more efficient treatment of diseases and a decrease in their morbidity and mortality rates. [9].
This study was undertaken after Ethical committee approval and after obtaining informed written consent from the patients involved.
Source of data: Patients visiting the outpatient and in-patient department of Department of General Surgery at a Tertiary Care Centre in Southern Rajasthan for a period of 1 year.
Type of study: Case series analysis on accrual patients.
Inclusion criteria: Patients presenting with upper gastrointestinal symptoms for at least 1 month, including those on medications for the same, more than 15 years of age and willing to provide informed consent before participation.
Exclusion criteria: Patient having undergone any previous upper gastrointestinal surgery or those with upper gastrointestinal obstructive symptoms, hematemesis or pregnant or lactating females.
Methodology:
All the patients underwent routine blood workup and were subjected to EGD. The patients were asked to fast for 6 hours prior to the procedure. Lignocaine gel was given orally for local anaesthesia following which mouthpiece was placed. Patient was made to lie on his/her left side and endoscope inserted. The instrument is advanced under direct vision, with the tip kept central. Esophagus was looked for inflammation, growth. The gastro-oesophageal junction was identified by the colour difference between oesophageal and gastric mucosa, and observed if closed or patulous. On entering the stomach, the anterior and posterior walls of the body were viewed along with the lesser and greater curvature. The proximal part of the curvatures were examined using the J manoeuvre. Stomach was observed for inflammation, ulcer, growth. Prepyloric and pyloric ring was observed directly. When the pylorus yields, complete assessment of the duodenum was done up to second part following which scope is removed. The patient was kept under observation.
The findings were categorised as oesophageal (esophagitis, hiatal hernia, others, normal), gastric (gastritis, gastric ulcer, malignancy, others, normal) and duodenal (duodenal ulcer, duodenitis, others, normal). The symptoms were correlated with these endoscopic findings.
Data processing and statistical analysis were performed using Microsoft Excel Spreadsheet and Openepi. Chi-square test was calculated and p value derived. A p-value <0>
Out of 68 patients, there were 42 (61.8%) males, 26 (38.2%) females, age ranging from 15 years to 75 years. The mean (SD) age of the patients in this study was 42 years (16.6).
Based on the sex of the patients:
The most common upper gastrointestinal symptom was epigastric pain, seen in 54 (79.4%) patients, followed by heartburn in 41 (60.3%) patients, post-prandial fullness in 23 (33.8%) patients and lastly regurgitation in 20 (29.4%) patients. Participants presented with ≥ 1 of these typical upper gastrointestinal symptoms. (Table I)
| Symptoms | Male, n= 42 n(%) | Female, n=26 n(%) | Total, n= 68 n(%) |
| Heartburn | 26 (61.9) | 15 (57.7) | 41 (60.3) |
| Regurgitation | 11 (26.2) | 9 (34.6) | 20 (29.4) |
| Epigastric pain | 30 (71.4) | 24 (92.3) | 54 (79.4) |
| Post prandial fullness | 16 (38.1) | 7 (26.9) | 23 (33.8) |
Table 1: Gender wise distribution of Upper Gastrointestinal symptoms among participants (138 symptoms in 68 participants).
Male patients were more likely to have symptoms of epigastric pain (p = 0.04). (Table II)
| Symptoms | Total, n = 68, n (%) | Sex | p-value | Chi2 value | |||
|---|---|---|---|---|---|---|---|
| Male, n = 42, n (%) | Female, n = 26, n (%) | ||||||
| Heartburn | |||||||
| Yes | 41 (60.3) | 26(61.9) | 15(57.7) | 0.73 | 0.119 | ||
| No | 27 (39.7) | 16(38.1) | 11(42.3) | ||||
| Regurgitation | |||||||
| Yes | 20 (29.4) | 11(26.2) | 9(34.6) | 0.46 | 0.549 | ||
| No | 48 (70.6) | 31 (73.8) | 17 (65.4) | ||||
| Epigastric pain | |||||||
| Yes | 54 (79.4) | 30(71.4) | 24(92.3) | 0.04 | 4.281 | ||
| No | 14 (20.6) | 12 (28.6) | 2 (7.7) | ||||
| Post-prandial fullness | |||||||
| Yes | 23 (33.8) | 16(38.1) | 7(26.9) | 0.34 | 0.895 | ||
| No | 45 (66.2) | 26 (61.9) | 19 (73.1) | ||||
Table 2: Association between digestive symptoms and sex of patients.
Analysis of various diseases on endoscopy showed that the most common pathology was inflammatory lesions seen in 46 (67.7%) of patients, of which 31(73.8%) were male patients and 15(57.7%) were female patients, followed by ulcers and erosions 11 (16.2%) of which 5 (11.9%) were male and 6 (23.1%) females. Hiatal hernia and GERD were seen in 10 (14.7%) of which 6 (14.3%) males and 4 (15.4%) females. Malignancy seen in 3 (4.4%) of which, 2 were males (4.8%) and 1 female (3.9%). (Table III)
Sl. No.
| Endoscopic finding | Male n= 42 n(%) | Female n= 26 n(%) | Total n= 68 n(%) |
| 1 | Normal | 4 (9.5) | 5 (19.2) | 9 (13.2) |
| 2 | Hiatus hernia/GERD | 6 (14.3) | 4 (15.4) | 10 (14.7) |
| 3 | Inflammatory lesions | 31 (73.8) | 15 (57.7) | 46 (67.7) |
| 4 | Malignancy | 2 (4.8) | 1 (3.9) | 3 (4.4) |
| 5 | Ulcer/Erosions | 5 (11.9) | 6 (23.1) | 11 (16.2) |
Table 3: Gender wise distribution of various diseases on endoscopy.
There was no statistically significant association between upper gastrointestinal endoscopy findings and sex of the participants. (Table IV)
| UGI Endoscopic findings | Total, n = 68, n (%) | Sex | p-value | Chi2 value | |||
|---|---|---|---|---|---|---|---|
| Male, n = 42, n (%) | Female, n = 26, n (%) | ||||||
| Normal | |||||||
| Yes | 9 (13.2) | 4(9.5) | 5(19.2) | 0.25 | 1.318 | ||
| No | 59 (86.8) | 38(90.5) | 21(80.8) | ||||
| Hiatus hernia/ GERD | |||||||
| Yes | 10 (14.7) | 6(14.3) | 4(15.4) | 0.90 | 0.015 | ||
| No | 58 (85.3) | 36(85.7) | 22(84.6) | ||||
| Inflammatory lesions | |||||||
| Yes | 46 (67.6) | 31(73.8) | 15(57.7) | 0.17 | 1.906 | ||
| No | 22 (32.4) | 11(26.2) | 11(42.3) | ||||
| Malignancy | |||||||
| Yes | 3 (4.4) | 2(4.8) | 1(3.9) | 0.86 | 0.031 | ||
| No | 65 (95.6) | 40(95.2) | 25(96.1) | ||||
| Ulcer | |||||||
| Yes | 11 (16.2) | 5(11.9) | 6(23.1) | 0.22 |
1.478 | ||
| No | 57 (83.8) | 37(88.1) | 20(76.9) | ||||
Table 4: Gender association with various endoscopic findings.
Based on the age of the patients:
All patients were subdivided into different age groups. Most commonly, clinically significant endoscopic findings were seen in age group between 26-35 years (n=18, 26.5%). (Table V)
| Age Groups | Number of Cases n= 68, n(%) |
| 15-25 | 14 (20.6) |
| 26-35 | 18 (26.5) |
| 36-45 | 9 (13.2) |
| 46-55 | 8 (11.8) |
| 56-65 | 10 (14.7) |
| 66-75 | 9 (13.2) |
Table 5: Age wise description of participants recruited for the study.
Participants presented with ≥ 1 of these typical upper gastrointestinal symptoms. The most common upper gastrointestinal symptom was epigastric pain, seen in 54 (79.4%) patients commonly in 26-35 year old participants, followed by heartburn in 41 (60.3%) patients in the same age group, post-prandial fullness in 23 (33.8%) patients under the age of 35 years and lastly regurgitation in 20 (29.4%) patients mostly falling in 26-35 year age group. (Table VI)
| Age groups | Heartburn n=41 (60.3%) | Regurgitation n=20 (29.4%) | Epigastric pain n=54 (79.4%) | Post prandial fullness n=23 (79.4%) | Total n=68 (%) |
| 15-25 | 10 | 3 | 13 | 6 | 32 (47.1) |
| 26-35 | 12 | 6 | 14 | 6 | 38 (55.9) |
| 36-45 | 3 | 2 | 8 | 1 | 14 (20.6) |
| 46-55 | 4 | 4 | 4 | 1 | 13 (19.1) |
| 56-65 | 7 | 2 | 9 | 4 | 22 (32.4) |
| 66-75 | 5 | 3 | 6 | 5 | 19 (27.9) |
Table 6: Age wise distribution of various upper gastrointestinal symptoms (138 symptoms in 68 participants).
There was no statistically significant association between symptoms of upper gastrointestinal disease and age group. (Table VII)
| Symptoms | 15-25 yrs n=14 | 26-35 yrs n=18 | 36-45 yrs n=9 | 46-55 yrs n=8 | 56-65 yrs n=10 | 66-75 yrs n=9 | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| n (%) | p-value, Chi2 value | n (%) | p-value, Chi2 value | n (%) | p-value, Chi2 value | n (%) | p-value, Chi2 value | n (%) | p-value, Chi2 value | n (%) | p-value, Chi2 value | |
| Heartburn | ||||||||||||
| Yes | 10 (71.4) | 0.33 0.91 | 12 (66.7) | 0.52 0.41 | 3 (33.3) | 0.07 3.15 | 4 (50) | 0.52 0.40 | 7 (70) | 0.46 0.49 | 5 (55.6) | 0.75 0.09 |
| No | 4 (28.6) | 6 (33.3) | 6 (66.7) | 4 (50) | 3(30) | 4 (44.4) | ||||||
| Regurgitation | ||||||||||||
| Yes | 3 (21.4) | 0.46 0.54 | 6 (33.3) | 0.67 0.18 | 2 (22.2) | 0.61 0.25 | 4 (50) | 0.17 1.85 | 2 (20) | 0.47 0.50 | 3 (33.3) | 0.78 0.07 |
| No | 11 (78.6) | 12 (66.7) | 7 (77.8) | 4 (50) | 8 (80) | 6 (66.7) | ||||||
| Epigastric pain | ||||||||||||
| Yes | 13 (92.9) | 0.16 1.95 | 14 (77.8) | 0.84 0.03 | 8 (88.9) | 0.45 0.56 | 4 (50) | 0.03 4.79 | 9 (90) | 0.36 0.80 | 6 (66.7) | 0.31 1.03 |
| No | 1 (7.1) | 4 (22.2) | 1 (11.1) | 4 (50) | 1 (10) | 3 (33.3) | ||||||
| Post-prandial fullness | ||||||||||||
| Yes | 6 (42.9) | 0.42 0.64 | 6 (33.3) | 0.95 0.002 | 1 (11.1) | 0.12 2.39 | 1 (12.5) | 0.17 1.84 | 4 (40) | 0.65 0.19 | 5 (55.6) | 0.13 2.18 |
| No | 8 (57.1) | 12 (66.7) | 8 (88.9) | 7 (87.5) | 6 (60) | 4 (44.4) | ||||||
Table 7: Association of digestive symptoms with age in patients.
Hiatus hernia/GERD and Inflammatory lesions (gastritis, esophagitis, duodenitis) were commonly seen in the age group between 26-35 years. Ulcer/erosions were commonly seen bimodally in the age groups between 56-65 and 26-35 years. Malignant lesions were seen in patients aged more than 26 years. (Table VIII)
| Age group (years) | Normal n=9 (13.2%) | Hiatus hernia/GERD n=10 (14.7%) | Inflammatory lesions n=46 (67.7%) | Malignancy n=3 (4.4%) | Ulcer/erosions n=11 (16.2%) | Total n=68 (%) |
| 15-25 | 3 | 2 | 9 | 0 | 1 | 15 (22.1) |
| 26-35 | 1 | 3 | 14 | 1 | 3 | 22 (32.4) |
| 36-45 | 2 | 0 | 5 | 0 | 2 | 9 (13.2) |
| 46-55 | 0 | 1 | 7 | 1 | 1 | 10 (14.7) |
| 56-65 | 2 | 2 | 5 | 1 | 3 | 13 (19.1) |
| 66-75 | 1 | 2 | 6 | 0 | 1 | 10 (14.7) |
Table 8: Age wise distribution of various diseases on upper gastrointestinal endoscopy.
There was no statistically significant association between upper gastrointestinal endoscopy findings and age group. (Table IX)
| Endoscopy findings | 15-25 yrs n=14 | 26-35 yrs n=18 | 36-45 yrs n=9 | 46-55 yrs n=8 | 56-65 yrs n=10 | 66-75 yrs n=9 | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| n (%) | p-value, Chi2 value | n (%) | p-value, Chi2 value | n (%) | p-value, Chi2 value | n (%) | p-value, Chi2 value | n (%) | p-value, Chi2 value | n (%) | p-value, Chi2 value | |
| Normal | ||||||||||||
| Yes | 3 (21.4) | 0.31 1.03 | 1 (5.6) | 0.26 1.25 | 2 (22.2) | 0.39 0.72 | 0 (0) | 0.24 1.38 | 2 (20) | 0.49 0.47 | 1 | 0.84 0.04 |
| No | 11 (78.6) | 17 (94.4) | 7 (77.8) | 8(100) | 8 (80) | 8 | ||||||
| Hiatus hernia/ GERD | ||||||||||||
| Yes | 2 (14.3) | 0.96 0.002 | 3 (16.7) | 0.78 0.07 | 0 (0) | 0.18 1.79 | 1 (12.5) | 0.85 0.04 | 2 (20) | 0.61 0.26 | 2 (22.2) | 0.49 0.47 |
| No | 12 (85.7) | 15 (83.3) | 9 (100) | 7 (87.5) | 8 (80) | 7 (77.8) | ||||||
| Inflammatory lesions | ||||||||||||
| Yes | 9 (64.3) | 0.76 0.09 | 14 (77.8) | 0.28 1.15 | 5 (55.6) | 0.41 0.69 | 7 (87.5) | 0.20 1.63 | 5 (50) | 0.19 1.67 | 6 (66.7) | 0.95 0.005 |
| No | 5 (35.7) | 4 (22.2) | 4 (44.4) | 1 (12.5) | 5 (50) | 3 (33.3) | ||||||
| Malignancy | ||||||||||||
| Yes | 0 (0) | 0.37 0.81 | 1 (5.6) | 0.78 0.08 | 0 (0) | 0.49 0.48 | 1 (12.5) | 0.24 1.41 | 1 (10) | 0.35 0.87 | 0 (0) | 0.49 0.48 |
| No | 14 (100) | 17 (94.4) | 9 (100) | 7 (87.5) | 9 (90) | 9 (100) | ||||||
| Ulcer | ||||||||||||
| Yes | 1 (7.1) | 0.31 1.06 | 3 (16.7) | 0.95 0.004 | 2 (22.2) | 0.60 0.28 | 1 (12.5) | 0.76 0.09 | 3 (30) | 0.20 1.65 | 1 (11.1) | 0.66 0.20 |
| No | 13 (92.9) | 15 (83.3) | 7 (77.8) | 7 (87.5) | 7 (70) | 8 (88.9) | ||||||
Table 9: Association of digestive symptoms with age of participants.
Out of 59 patients with clinically significant endoscopic findings, most common pathology was seen in stomach with 49 (62.8%) patients followed by 21 (26.9%) patients having oesophageal pathologies and 8 patients (10.3%) having pathologies in the duodenum. (Table X) Multiple sites may be involved in a single participant.
| Site of lesions | Cases |
| Oesophagus | 21 (26.9%) |
| Stomach | 49 (62.8%) |
| Duodenum | 8 (10.3%) |
Table 10: Distribution of clinically significant endoscopic finding according to the site of lesions (78 sites involved in 68 participants).
The most frequent abnormalities detected by endoscopy in the studied sample were inflammatory conditions (oesophagitis, gastritis, duodenitis) (n=46). Heartburn was found to be a significant symptom for all conditions. Regurgitation was a significant symptom in largely normal endoscopic findings (0.019). Participants with epigastric pain significantly had either hiatus hernia/GERD (p=0.005) or Inflammatory conditions (p=0.009). Post-prandial fullness was significantly associated with inflammatory conditions (p=0.042). (Table XI, XII)
| Symptoms | Normal | Hiatus hernia/GERD | Inflammatory lesions | Malignancy | Ulcer/erosions | Total |
| Heartburn | 2 | 7 | 41 | 1 | 3 | 54 |
| Regurgitation | 0 | 5 | 18 | 2 | 4 | 29 |
| Epigastric pain | 9 | 6 | 44 | 2 | 8 | 69 |
| Post prandial fullness | 3 | 2 | 23 | 0 | 4 | 32 |
| Total | 14 | 20 | 126 | 5 | 19 | 184 |
Table 11: Association between upper gastrointestinal symptoms and endoscopic findings.
| Symptoms | Normal, n=9 | Hiatus/Gerd, n=10 | Inflammatory, n=46 | Malignancy, n=3 | Ulcer, n=11 | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| n (%) | p-value, Chi2 value | n (%) | p-value, Chi2 value | n (%) | p-value, Chi2 value | n (%) | p-value, Chi2 value | n (%) | p-value, Chi2 value | |
| Heartburn | ||||||||||
| Yes | 2 (22.2) | 0.0015 9.9 | 7 (70) | 0.014 0.90 | 41(89.1) | 0.000002 21.97 | 1 (33.3) | 0.18 1.77 | 3 (27.2) | 0.0016 9.97 |
| No | 7 (77.8) | 3 (30) | 5 (10.9) | 2 (66.7) | 8 (72.7) | |||||
| Regurgitation | ||||||||||
| Yes | 0 (0) | 0.015 5.81 | 5 (50) | 0.35 0.87 | 18(39.1) | 0.6 0.28 | 2 (66.7) | 0.27 1.2 | 4 (36.4) | 0.98 0.0007 |
| No | 9 (100) | 5 (50) | 28(60.9) | 1 (33.3) | 7 (63.6) | |||||
| Epigastric pain | ||||||||||
| Yes | 9 (100) | 0.23 1.47 | 6 (60) | 0.005 7.74 | 44(95.7) | 0.009 6.88 | 2 (66.7) | 0.27 1.20 | 8 (72.7) | 0.11 2.46 |
| No | 0 (0) | 4 (40) | 2 (4.3) | 1 (33.3) | 3 (27.2) | |||||
| Post-prandial fullness | ||||||||||
| Yes | 3 (33.3) | 0.64 0.21 | 2 (20) | 0.15 1.99 | 23 (50) | 0.042 4.12 | 0 (0) | 0.15 2.12 | 4 (36.4) | 0.76 0.09 |
| No | 6 (66.7) | 8 (80) | 23 (50) | 3 (100) | 7 (63.6) | |||||
Table 12: Association between digestive symptoms and abnormalities detected by endoscopy in patients.
The most prevalent upper gastrointestinal digestive symptoms were epigastric pain, followed by heartburn and post-prandial fullness. These data suggest that the intensity of the pain and gastric discomfort combined with the fear of serious diseases are the main reasons for seeking a clinical opinion. [11]
Comparison of clinical presentations:
Out of 68 patients, 54 (79.4%) had epigastric pain and discomfort as their chief complaint. The other complaints were heart burn 41(60.3%), post prandial fullness 23(33.8%), regurgitation 20(29.4%). A study conducted in the southeast region of Brazil on patients with dyspepsia showed that epigastric pain was reported in 10%, post-prandial plenitude in 6.7%, and heartburn in 52.8% of patients. [12] In the United States, research involving patients with dyspepsia showed a prevalence of 51% for epigastric pain and 47% for post-prandial discomfort. The prevalence of heartburn was approximately 35.3% among the patients who had this symptom at least once a month, [13] which agrees with our study's data. Similar study was conducted by Thomson A B R et al [46], in which the
common presenting complaints were upper abdominal pain (34.3%), heart burn (24.5%) and acid regurgitation (13.3%), the observations were comparable with that of the present study. In a population study conducted in Asia, the authors found that the prevalence of epigastric pain was 20.2% and that of heartburn was 2.1%. The variation of symptoms observed in different countries suggests a difference in the pattern of development of digestive symptoms between western and oriental cultures, in addition to differences in the diagnostic instruments used. [14,15]
Comparison of gender distribution:
In this study 61.8% were males, 38.2% were females with men more likely than women to have gastrointestinal symptoms. However, the p-value was insignificant suggestive of equivocal distribution among both genders. The male to female ratio in the studies conducted by Khan N et al – 2.3:1, Tidake et al – 1.08:1, Du et al- 1.3:1 respectively. In these studies, the majority of patients were males as observed in our study. [16,17,18] In a population-based study in Australia, females significantly outnumbered males in most functional gastrointestinal disorders includes functional dyspepsia. The higher frequency of digestive symptoms in women was also observed in other studies. [12,19,20] (Table XIII)
| Sl. No. | Name of Study | Male:Female ratio |
| 1 | Khan N et al | 2.3:1 |
| 2 | Tidake et al | 1.08:1 |
| 3 | Du et al | 1.3:1 |
| 4 | Almeida AM et al | 0.7:1 |
| 5 | Rodríguez-García JL et al | 1:1 |
| 6 | Present study | 1.6:1 |
Table 13: Comparison of gender distribution between various studies.
The differences between gastrointestinal symptoms in men and women may be related to differences in the production of gastric hormones between the sexes that are responsible for the higher motility of the gastrointestinal tract, such as ghrelin, in addition to psychosocial factors,
alcoholism, smoking and lifestyle choices. [21,22,23] A study in South Korea evaluating differences between the sexes in the production of ghrelin, psychological factors, and quality of life in patients with dyspepsia demonstrated that men produced a lower amount of ghrelin, and women had a higher score of anxiety and depression, whereas the anxiety score was associated with epigastric pain only in female patients. [22]
Comparison of age:
Most of the patients in this study were in the age group of 26-55 years constituting 51.5% of total cases with a mean age of 42 years. Even similar studies like Tidake et al. and Wang et al. showed an incidence of 50% and 70%, respectively, among similar age group of 30-60 years. [17,24]
Comparison of endoscopic findings:
In the present study, clinically significant endoscopic findings were observed in 59 patients accounting for 86.8%. Gastritis was the most common finding (55.9%), while esophagitis was found in 16.2%. The next common findings were gastric ulcer, duodenitis, GERD. The percentage of cases with gastritis in this study was higher than that observed in studies by Sarwar et al and Ziauddin. The percentage of patients GERD was nearly equal to that observed by Ziauddin et al. (Table XIV)
| Sl. No. | Name of the study | Gastritis | Reflux esophagitis/GERD |
| 1 | Sarwar et al. [27] | 13% | 20% |
| 2 | Ziauddin | 18% | 14% |
| 3 | Present study | 55.9% | 16.2% |
Table 14: Comparison of endoscopic findings between various studies.
Comparison of incidence of gastric malignancies: The incidence of gastric malignancy in various studies is comparable with those observed in the present study. (Table XV
| Sl. No. | NAME OF STUDY | GASTRIC MALIGNANCIES (%) |
| 1 | Choomsri P et al. [28] | 1% |
| 2 | Khan N et al. [16] | 3% |
| 3 | Ziauddin | 4% |
| 4 | Present study | 4.4% |
Table 15: Comparison of incidence of gastric malignancies between various studies.
The current study revealed that there was some significant association between digestive symptoms and abnormalities detected by endoscopy. The most frequent abnormality detected by endoscopy were inflammatory lesions. Dyspepsia occurs frequently in the population at large and have significant overlapping of symptoms; therefore, knowledge of the underlying clinical cause of these symptoms could help perfect the management of upper gastrointestinal diseases. [25,26]
Therefore, we need to investigate the factors that contribute to the appearance of digestive symptoms through a personalised and multi-professional approach. This will improve the early detection and treatment of upper digestive tract diseases and improve the quality of care provided. The development of similar research in different geographic regions with different methodological approaches will enable full comprehension of the topic.
Limitations, such as obtaining study sample from a single centre and lack of follow-up of the study's participants were noted. Our evaluation relied on self-reporting. Finally, recall bias may have occurred because symptoms were investigated that occurred within the past.
From the present study, on endoscopic examination, gastritis accounted for the majority of the cases. Incidence of malignancy in the present study was observed to be 4.4%. Clinically significant endoscopic findings were observed in 86.8% of patients with dyspepsia. In our study, endoscopic findings correlated well with signs and symptoms of majority of patients. Most patients presented with a complex of two or more dyspeptic symptoms and the symptom profile was occasionally predictive of the endoscopic findings. Prevalence of large number of inflammatory lesions as a result of increased acid production, with a low incidence of malignancy in the study group suggests that the un-investigated patients with dyspepsia may be initially managed medically with acid suppressive therapy. Endoscopy may be undertaken in patients with recurrent symptoms or in whom drug therapy fails. Upper gastro-intestinal endoscopy therefore is a simple, safe, reliable and valuable tool with an easy learning curve. It enables direct visualization of the upper GI tract and when combined with histopathological examination helps in diagnosing as well as for therapeutic interventions for patients with various pathologies. Upper GI endoscopy will remain as the initial investigation of choice for the patients presenting with upper GI symptoms.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
