Clinical usefulness of gastric-juice analysis in 2007: the stone that the builders rejected has become the cornerstone
Clinical usefulness of gastric-juice analysis in 2007: the stone that the builders rejected has become the cornerstone
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DOI：
10.1016/j.gie.2007.03.1052
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发表时间：
2007-11-01
影响因子：
7.7
通讯作者：
Caletti, Giancarlo
中科院分区：
文献类型：
--
作者：
Tucci, Antonio;Bisceglia, Michele;Caletti, Giancarlo
背景：胃液在上消化道内窥镜检查过程中通常会被丢弃，目的：通过使用新型设备 Mt 21-42，我们评估了这种重要有机液体在临床实践中的潜力，探索其对诊断幽门螺杆菌感染和泌酸粘膜萎缩性胃炎 (AGOM) 的贡献。设计和患者：一项多中心研究（17,907 名患者；10 个内窥镜检查单位）估计了 AGOM 和 H 的诊断频率常规内镜检查中的幽门螺杆菌感染。在这些单位进行的一项前瞻性研究（216 名患者）旨在确定这些病症的真实患病率以及胃液分析的可能益处。我们考虑了胃液 pH 值和铵浓度、内窥镜和组织学特征、萎缩和幽门螺杆菌的血清学参数、胃酸分泌和成本。结果：我们发现，由于传统测试和幽门螺杆菌的内在局限性，在常规内窥镜实践中，幽门螺杆菌感染以及更明显的是 AGOM 的诊断率分别为 20.1% 和 0.8%，前瞻性研究中分别为 49.1% 和 12.5%）。缺乏/不适当的活检计划。胃液分析被证明是一种廉价、简单、有效的方法来防止这种漏诊，并允许在 96% 和 98% 的病例中检测出萎缩性胃炎和幽门螺杆菌，并节省成本（成本效益比 209 vs 274-5047）。结论：胃液提供了临床病理信息的宝贵来源，经过正确分析，可以检测胃癌的主要危险因素（幽门螺杆菌和幽门螺杆菌）。萎缩性胃炎），克服了与这些疾病相关的诊断局限性，并节省了时间和成本。
Background: Gastric juice is usually discarded during upper-GI endoscopy,Objective: By using a novel device, the Mt 21-42, we evaluated the potential of this important organic fluid in clinical practice, exploring its contribution to the diagnosis of Helicobacter pylori infection and atrophic gastritis of the oxyntic mucosa (AGOM).Design and Patients: A multicenter study (17,907 patients; 10 endoscopy units) estimated the frequency of diagnosis of AGOM and H pylori infection in routine endoscopic practice. A prospective study (216 patients) at I of these units aimed to determine the real prevalence of these conditions and the possible benefits of gastric juice analysis. We considered gastric juice pH and ammonium concentration, endoscopic and histologic features, serologic parameters for atrophy and H pylori, gastric acid secretion, and costs.Results: We found that H pylori infection and, even more markedly, AGOM were greatly underdiagnosed in routine endoscopic practice (20.1% and 0.8% vs 49.1% and 12.5% in the prospective study, respectively), because of the intrinsic limitations of the conventional tests and lack/inappropriateness of biopsy planning. Gastric-juice analysis proved to be a cheap, simple, and effective way to prevent such underdiagnosis and allowed detection of atrophic gastritis and H pylori in 96% and 98% of cases, and saved costs (cost-effectiveness ratio 209 vs 274-5047).Conclusions: Gastric juice provided a valuable source of clinicopathologic information that, properly analyzed, allowed detection of the main risk factors for gastric cancer (H pylori and atrophic gastritis), overcoming the diagnostic limitations associated with these conditions and also producing time and cost savings.