Relative frequency of upper gastrointestinal and colonic lesions in patients with positive fecal occult-blood tests
Relative frequency of upper gastrointestinal and colonic lesions in patients with positive fecal occult-blood tests
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DOI：
10.1056/nejm199807163390303
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发表时间：
1998-07-16
影响因子：
158.5
通讯作者：
McQuaid, K
中科院分区：
文献类型：
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作者：
Rockey, DC;Koch, J;McQuaid, K
背景虽然出血病变在胃肠道的任何地方都可以引起阳性反应愈创木基粪便潜血试验，上消化道和结肠病变的相对频率是unknown.Methods在一段时间的30个月，我们前瞻性研究了所有患者至少有一个粪便标本含有粪便潜血谁被转介作进一步评估。粪便潜血通过常规筛查获得的粪便标本或直肠指检获得的粪便的标准愈创木基试验检测。有记录的缺铁性贫血或活动性胃肠道出血的患者被排除在研究之外。所有的参与者都采取了详细的历史，并进行结肠镜检查，其次是食管胃镜检查。结果的409例粪便潜血谁是指，310可能有资格参加，和248（平均年龄，61岁;范围，40至89）进行了研究; 40%是女性。我们在119名患者（48%）中发现了与隐匿性出血一致的病变;在71例出血病变中发现了上消化道，在54例中发现了结肠。6例患者在这两个领域都有异常。最常见的上消化道病变为食管炎（23例）、胃溃疡（14例）、胃炎（12例）和十二指肠溃疡（10例）。30例上消化道病变患者长期使用阿司匹林、乙醇、非甾体类抗炎药或这些药物的组合。最常见的结肠病变为直径大于1.0cm的腺瘤（29例）、癌（13例）、结肠炎（5例）和血管扩张（5例）。虽然症状对胃肠道病变检测的总体敏感性较低，但逻辑回归分析表明，上消化道症状的存在与上消化道病变的检测相关（比值比，2.6; 95%置信区间，1.4至4.7）。在有症状和没有症状的患者，病变的患病率在上消化道大于或等于结肠loses.Conclusions在一组患者阳性粪便潜血试验谁被称为进一步评估，从这些与缺铁性贫血和活动性出血已被排除在外，上消化道病变被确定为更频繁比结肠病变。（N Engl J Med 1998; 339：153-9.）（C）1998年，马萨诸塞州医学会。
Background Although bleeding lesions anywhere in the gastrointestinal tract can cause a positive reaction on guaiac-based fecal occult-blood tests, the relative frequency of upper gastrointestinal and colonic lesions is unknown.Methods During a period of 30 months, we prospectively studied all patients with at least one stool specimen containing fecal occult blood who were referred for further evaluation. Fecal occult blood was detected by standard guaiac-based tests of stool specimens obtained as part of routine screening or of stool obtained by digital rectal examination. Patients with documented iron-deficiency anemia or active gastrointestinal bleeding were excluded from the study. All participants had a detailed history taken and underwent colonoscopy, followed by esophagogastroduodenoscopy.Results Of the 409 patients with fecal occult blood who were referred, 310 were potentially eligible to participate, and 248 (mean age, 61 years; range, 40 to 89) were studied; 40 percent were women. We identified lesions consistent with occult bleeding in 119 patients (48 percent); in 71 bleeding lesions were found in the upper gastrointestinal tract, and in 54 they were identified in the colon. Six patients had abnormalities in both areas. The most common upper gastrointestinal lesions were esophagitis (23 patients), gastric ulcer (14), gastritis (12), and duodenal ulcer (10). Thirty patients with lesions in the upper gastrointestinal tract were long-term users of aspirin, ethanol, nonsteroidal antiinflammatory drugs, or a combination of these substances. The most com mon colonic lesions were adenomas more than 1.0 cm in diameter (29 patients), carcinoma (13), colitis (5), and vascular ectasia (5). Although the overall sensitivity of symptoms for the detection of gastrointestinal lesions was low, logistic-regression analysis demonstrated that the presence of symptoms in the upper gastrointestinal tract was associated with the detection of lesions in the upper gastrointestinal tract (odds ratio, 2.6; 95 percent confidence interval, 1.4 to 4.7). In both patients with symptoms and those without symptoms, the prevalence of lesions in the upper gastrointestinal tract was greater than or equal to that of colonic lesions.Conclusions In a group of patients with positive fecal occult-blood tests who were referred for further evaluation, from which those with iron-deficiency anemia and active bleeding had been excluded, up per gastrointestinal lesions were identified more frequently than colonic lesions. (N Engl J Med 1998; 339:153-9.) (C)1998, Massachusetts Medical Society.