Fraser Alan, Williamson Susan, Lane Mark, Hollis Brian
Department of Medicine, University of Auckland, Auckland, New Zealand.
N Z Med J. 2003 Jun 20;116(1176):U479.
To audit the results of a nurse-led dyspepsia clinic.
Referrals to the Gastroenterology Department at Auckland Hospital for gastroscopy were assessed in a dyspepsia clinic. Initial evaluation included consultation and a urea breath test (UBT). Patients given eradication treatment prior to initial clinic assessment were excluded. Patients with a positive UBT were given eradication treatment and were reviewed two months later for symptom assessment and follow-up UBT. Patients with a negative UBT were usually referred back to the GP.
There were 173 patients; mean age 38 years; 73 had a positive UBT (42%). A positive UBT was significantly associated with place of birth (NZ 16%; other place of birth 60%; p = 0.001). If the dominant symptom was epigastric pain 54% had a positive UBT; if it was reflux or bloating 29% were positive, p = 0.005. Forty nine UBT-positive patients had follow-up data and of these 43 had successful eradication (88%). Of patients with successful eradication, 40% had an excellent response, 38% improved, and 22% were not improved. After a mean follow up of 3.3 years 42/173 (24%) patients had a gastroscopy. Of these, 30 were initially UBT negative and 12 were UBT positive (9 had been successfully eradicated). The endoscopic findings were normal in 27, reflux oesophagitis in 13, pyloric stenosis in one, and gastric ulcer (HP+ve) in one. Helicobacter pylori status by biopsy was consistent with the UBT result. One hundred and thirteen patients also had H. pylori serology (Cobas Core, Roche) performed. There were three false negatives (negative predictive value of 94% [51/54]) and seven false positives (positive predictive value of 88% [52/59]).
The urea breath test was found to be useful as part of the initial assessment of selected patients who would otherwise have been referred for endoscopy. It is likely that the need for gastroscopy was reduced, but longer follow up will be required to determine whether or not this effect is simply due to delayed referral. This approach is likely to have value only in patients who have a relatively high chance of being H. pylori positive.
审核由护士主导的消化不良诊所的诊疗结果。
在一家消化不良诊所对奥克兰医院胃肠病科胃镜检查转诊病例进行评估。初始评估包括会诊和尿素呼气试验（UBT）。在初始诊所评估前接受根除治疗的患者被排除。UBT结果呈阳性的患者接受根除治疗，并在两个月后接受复查以评估症状和进行随访UBT。UBT结果呈阴性的患者通常被转回给全科医生。
共有173例患者；平均年龄38岁；73例UBT结果呈阳性（42%）。UBT结果呈阳性与出生地显著相关（新西兰16%；其他出生地60%；p = 0.001）。如果主要症状是上腹部疼痛，54%的患者UBT结果呈阳性；如果是反流或腹胀，29%的患者呈阳性，p = 0.005。49例UBT结果呈阳性的患者有随访数据，其中43例根除成功（88%）。在根除成功的患者中，40%反应极佳，38%有所改善，22%未改善。平均随访3.3年后，173例患者中有42例（24%）接受了胃镜检查。其中，30例最初UBT结果呈阴性，12例UBT结果呈阳性（9例已成功根除）。内镜检查结果显示，27例正常，13例为反流性食管炎，1例为幽门狭窄，1例为胃溃疡（幽门螺杆菌阳性）。通过活检得出的幽门螺杆菌状态与UBT结果一致。113例患者还进行了幽门螺杆菌血清学检测（Cobas Core，罗氏公司）。有3例假阴性（阴性预测值为94%[51/54]）和7例假阳性（阳性预测值为88%[52/59]）。
发现尿素呼气试验作为部分特定患者初始评估的一部分很有用，否则这些患者会被转诊进行内镜检查。胃镜检查的需求可能减少了，但需要更长时间的随访来确定这种效果是否仅仅是由于转诊延迟。这种方法可能仅对幽门螺杆菌阳性可能性相对较高的患者有价值。
