Sung J J, Lao W C, Lai M S, Li T H, Chan F K, Wu J C, Leung V K, Luk Y W, Kung N N, Ching J Y, Leung W K, Lau J, Chung S J
Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, NT, Hong Kong.
Gastrointest Endosc. 2001 Oct;54(4):454-8. doi: 10.1067/mge.2001.118254.
A "test-and-treat" strategy for H pylori infection has been recommended in Europe and North America as safe and cost-effective for management of patients with dyspepsia. The primary aim of this study was to determine the frequency of gastroesophageal cancer in 2 groups of patients with dyspepsia: those 45 years of age or younger without "alarm" symptoms (low-risk group) and patients over 45 years of age or any patient with "alarm" symptoms (high-risk group). A secondary aim was to determine the frequency of gastric cancer among patients in the low-risk group with or without a positive serology for H pylori.
Patients with persistent dyspepsia were recruited from 4 regional hospitals in Hong Kong. Those in the low-risk group were evaluated for H pylori by using a whole blood serology test; they underwent endoscopy within 1 week. Those in the high-risk group and those taking nonsteroidal anti-inflammatory drugs (NSAIDs) underwent endoscopy promptly. Alarm symptoms were as follows: weight loss (10 or more pounds over 8 weeks), recurrent vomiting, dysphagia, bleeding, or anemia.
Of 2627 patients enrolled, 1017 were in the low-risk group and 1610 in the high-risk group. Twenty-three patients (0.9%) had gastroesophageal cancers (20 gastric, 3 esophageal). Four patients with cancer (17.4%) were in the low-risk group (3 gastric, 1 esophageal); all except the patient with esophageal cancer had a positive serology test. In the high-risk group, 19 patients had cancer (17 gastric, 2 esophageal).
Gastric cancer is relatively frequent among young patients with dyspepsia who have no alarm features in Hong Kong. This finding raises concerns as to the safety of the "test-and-treat" strategy for the management of patients with dyspepsia in Asia.
在欧洲和北美，幽门螺杆菌感染的“检测和治疗”策略被推荐用于消化不良患者的管理，认为其安全且具有成本效益。本研究的主要目的是确定两组消化不良患者中胃食管癌的发生率：45岁及以下无“警示”症状的患者（低风险组）和45岁以上或有任何“警示”症状的患者（高风险组）。次要目的是确定低风险组中幽门螺杆菌血清学检测阳性或阴性的患者中胃癌的发生率。
从香港4家地区医院招募持续性消化不良患者。低风险组患者采用全血血清学检测评估幽门螺杆菌感染情况；他们在1周内接受内镜检查。高风险组患者和服用非甾体抗炎药（NSAIDs）的患者立即接受内镜检查。警示症状如下：体重减轻（8周内超过10磅）、反复呕吐、吞咽困难、出血或贫血。
在纳入的2627例患者中，1017例属于低风险组，1610例属于高风险组。23例患者（0.9%）患有胃食管癌（20例胃癌，3例食管癌）。4例癌症患者（17.4%）在低风险组（3例胃癌，1例食管癌）；除食管癌患者外，所有患者血清学检测均为阳性。在高风险组中，19例患者患有癌症（17例胃癌，2例食管癌）。
在香港，无警示特征的年轻消化不良患者中胃癌相对常见。这一发现引发了对亚洲消化不良患者“检测和治疗”策略安全性的担忧。
