Bartels F, Hahn H-J, Stolte M, Schmidt-Wilcke H A
St.-Vincenz-Hospital GmbH, Coesfeld.
Z Gastroenterol. 2003 Apr;41(4):311-8. doi: 10.1055/s-2003-38645.
The aim of this clinical investigation was to register the frequency of endoscopically defined diseases of the upper intestinal tract in a given region (Münster and Münsterland) within the period of one year (1.8.1999-31.7.2000). Furthermore, we tried to get an impression on the quality of the upper intestinoscopies by standardised conditions which had been developed by a steering committee (endoscopists and pathologists). 20 physicians (internal specialists and gastroenterologists) examined non-preselected patients and registered all relevant findings in the upper intestinal tract. The following items were of special interest: sex, age, operations in the past, indication, way of preparation, local findings (in the upper intestinal tract), and histological assessment. The examination forms were gathered, checked for completeness and evaluated statistically. Within the given period 8859 examinations forms (45.2% male and 54% female) could be evaluated. In 16% of the patients a reflux oesophagitis was diagnosed, three times more frequently than could have been expected anamnestically regarding the patients' complaints. In 274 patients (3%) the endoscopist suspected a Barrett's oesophagus; the according histological examination confirmed this suspicion in only 125 cases. Furthermore 17 adenocarcinomas and 13 squamous cell carcinomas were found. Macroscopically 44 polyps were registered but not all of them were biopsied. In 257 patients oesophageal varices (of varying degrees) were described. Only in 30.7% of the patients a H. pylori infection (diagnosed by urease test and by histological examination) was detected in the mucosa of the stomach. In 172 patients a gastritis was macroscopically suspected but the following histological assessments were not sufficient. The prevalence of gastric ulcers was 10 %, higher than the prevalence of duodenal ulcers. Only in 50% of the patients with a duodenal ulcer a H. pylori infection could be detected. In 51 cases carcinomas (diagnosis histologically confirmed) were found with the same ratio of the diffuse type and the intestinal type. In 18 patients a carcinoma could be detected in the neighbouring area of gastric ulcers. The endoscopic findings in this investigation do not differ significantly from the results found in literature. It is important that there are more gastric ulcers than duodenal ulcers. This can be explained by the frequent use of PPIs which are prescribed additionally to NSARs and ASS. The deficits of histological diagnostics on Barett's oesophagus and gastritis were remarkable. An improvement of the endoscopic and histologic assessment quality by valid standards systematically applied should be aimed at in future. Furthermore it could be helpful to use the same nomenclature for pathologic findings to intensify the co-operation between the physicians in hospitals and the practitioners.
本临床研究的目的是记录某一特定地区(明斯特和明斯特兰)在一年期间(1999年8月1日至2000年7月31日)上消化道内镜确诊疾病的发生率。此外,我们试图通过由一个指导委员会(内镜医师和病理学家)制定的标准化条件来了解上消化道内镜检查的质量。20名医生(内科专家和胃肠病学家)对未预先挑选的患者进行检查,并记录上消化道的所有相关发现。以下项目特别令人关注:性别、年龄、既往手术史、检查指征、准备方式、局部发现(在上消化道)以及组织学评估。收集检查表格,检查完整性并进行统计学评估。在给定期间内,8859份检查表格(男性占45.2%,女性占54%)可供评估。16%的患者被诊断为反流性食管炎,比根据患者主诉通过回忆预期的频率高出三倍。274例患者(3%)内镜医师怀疑有巴雷特食管;相应的组织学检查仅在125例中证实了这一怀疑。此外,发现了17例腺癌和13例鳞状细胞癌。肉眼观察记录了44个息肉,但并非所有息肉都进行了活检。257例患者描述有不同程度的食管静脉曲张。仅30.7%的患者胃黏膜检测到幽门螺杆菌感染(通过尿素酶试验和组织学检查诊断)。172例患者肉眼怀疑有胃炎,但随后的组织学评估不充分。胃溃疡的患病率为10%,高于十二指肠溃疡的患病率。仅50%的十二指肠溃疡患者能检测到幽门螺杆菌感染。51例患者发现癌(组织学诊断确诊),弥漫型和肠型比例相同。18例患者在胃溃疡邻近区域检测到癌。本研究中的内镜检查结果与文献报道结果无显著差异。胃溃疡比十二指肠溃疡更多这一点很重要。这可以通过在非甾体抗炎药和阿司匹林之外频繁使用质子泵抑制剂来解释。巴雷特食管和胃炎的组织学诊断缺陷显著。未来应旨在通过系统应用有效标准来提高内镜和组织学评估质量。此外,使用相同的病理发现命名法可能有助于加强医院医生和从业者之间的合作。