{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T06:35:25Z","timestamp":1792564525787,"version":"4.5.0"},"reference-count":18,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Frontline Gastroenterol"],"accepted":{"date-parts":[[2021,2,16]]},"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Debate is ongoing regarding the need for universal endoscopic follow-up to ensure gastric ulcer healing. We aimed to assess the value of follow-up oesophago-gastro-duodenoscopies (OGDs) for gastric ulcer healing and stratify patients according to risk of malignancy by developing a risk score.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design\/method<\/jats:title>\n                  <jats:p>All patients in National Health Service (NHS) Lothian with an index OGD and a diagnosis of gastric ulcer between 1 January 2014 and 31 December 2018 were identified. Data were analysed with logistic regression to identify factors significantly associated with a diagnosis of cancer; a risk score was derived and externally validated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>778 patients were identified and 60.3% (469\/778) of patients had a follow-up OGD. 8.6% (66\/778) of patients were diagnosed with cancer. No cases of cancer were found on follow-up OGD of a benign appearing ulcer with negative biopsies. Macroscopic suspicion of malignancy was present at index OGD in 100% (3\/3) of those diagnosed with cancer on subsequent OGDs. Older age (p=0.014), increased ulcer size (p&lt;0.001) and non-antral location (p=0.030) were significantly associated with malignancy. A risk score (area under the curve (AUC) 0.868, p&lt;0.001, minimum score=0, maximum score=6) was derived from these variables. 78.0% of patients with malignant ulcers scored \u22653, only 15.8% with benign ulcers scored \u22653 (negative predictive value (NPV) 97.4%). External validation yielded an AUC of 0.862 (p&lt;0.001) and NPV of 98.6%; 84.0% of those with malignant ulcers scored \u22653.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Ulcers with a combination of macroscopically benign appearances, at least six negative biopsies and a low risk score do not necessarily need endoscopic follow-up.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/flgastro-2020-101759","type":"journal-article","created":{"date-parts":[[2021,2,26]],"date-time":"2021-02-26T13:23:10Z","timestamp":1614345790000},"page":"111-118","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Risk stratifying gastric ulcers: development and validation of a scoring system"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8972-0332","authenticated-orcid":false,"given":"William M","family":"Brindle","sequence":"first","affiliation":[{"name":"The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9440-1192","authenticated-orcid":false,"given":"Rebecca K","family":"Grant","sequence":"additional","affiliation":[{"name":"The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne","family":"Smith","sequence":"additional","affiliation":[{"name":"The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan","family":"Suddaby","sequence":"additional","affiliation":[{"name":"The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angus","family":"Wallace","sequence":"additional","affiliation":[{"name":"The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah-Louise","family":"Gillespie","sequence":"additional","affiliation":[{"name":"The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas I","family":"Church","sequence":"additional","affiliation":[{"name":"The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin L","family":"Noble","sequence":"additional","affiliation":[{"name":"The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0785-6744","authenticated-orcid":false,"given":"Ian D","family":"Penman","sequence":"additional","affiliation":[{"name":"The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John N","family":"Plevris","sequence":"additional","affiliation":[{"name":"The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander R","family":"Robertson","sequence":"additional","affiliation":[{"name":"The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleanor F","family":"Watson","sequence":"additional","affiliation":[{"name":"The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2022-5859","authenticated-orcid":false,"given":"Christian P","family":"Selinger","sequence":"additional","affiliation":[{"name":"Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3276-6751","authenticated-orcid":false,"given":"Rahul","family":"Kalla","sequence":"additional","affiliation":[{"name":"The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gail S M","family":"Masterton","sequence":"additional","affiliation":[{"name":"The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,2,26]]},"reference":[{"key":"2025090708051957000_13.2.111.1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2010.228254"},{"key":"2025090708051957000_13.2.111.2","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2017-314109"},{"key":"2025090708051957000_13.2.111.3","doi-asserted-by":"crossref","first-page":"l5495","DOI":"10.1136\/bmj.l5495","article-title":"Peptic ulcer disease","volume":"16","author":"Sverd\u00e9n","year":"2019","journal-title":"BMJ"},{"key":"2025090708051957000_13.2.111.4","unstructured":"NICE Pathway . Managing peptic ulcer disease in adults; 2020."},{"key":"2025090708051957000_13.2.111.5","unstructured":"Public Health Scotland . Stomach cancer statistics, 2020. Available: https:\/\/www.isdscotland.org\/Health-Topics\/Cancer\/Cancer-Statistics\/Stomach\/ [Accessed 11 Aug 2020]."},{"key":"2025090708051957000_13.2.111.6","doi-asserted-by":"publisher","DOI":"10.1136\/gut.21.1.9"},{"key":"2025090708051957000_13.2.111.7","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1097\/00004836-198608000-00009","article-title":"Endoscopic follow-up of patients with gastric ulcer. 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Stomach cancer incidence rates. Available: https:\/\/www.cancerresearchuk.org\/health-professional\/cancer-statistics\/statistics-by-cancer-type\/stomach-cancer\/incidence#heading-One [Accessed 16 Jan 2021]."},{"key":"2025090708051957000_13.2.111.17","unstructured":"Scottish National Tariff . Public health Scotland, 2013\/2014. Available: https:\/\/www.isdscotland.org\/Health-Topics\/Finance\/Scottish-National-Tariff\/ [Accessed 11 Aug 2020]."},{"key":"2025090708051957000_13.2.111.18","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/s00508-012-0309-8","article-title":"The usefulness of ulcer size and location in the differential diagnosis of benign and malignant gastric ulcer","volume":"125","author":"Ko\u00e7ak","year":"2013","journal-title":"Wien Klin Wochenschr"}],"container-title":["Frontline Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/flgastro-2020-101759","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,7]],"date-time":"2025-09-07T15:05:31Z","timestamp":1757257531000},"score":1,"resource":{"primary":{"URL":"https:\/\/fg.bmj.com\/lookup\/doi\/10.1136\/flgastro-2020-101759"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,26]]},"references-count":18,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,2,7]]},"published-print":{"date-parts":[[2022,3]]}},"alternative-id":["10.1136\/flgastro-2020-101759"],"URL":"https:\/\/doi.org\/10.1136\/flgastro-2020-101759","relation":{},"ISSN":["2041-4137","2041-4145"],"issn-type":[{"value":"2041-4137","type":"print"},{"value":"2041-4145","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,26]]}}}