Schmidt N, Peitz U, Lippert H, Malfertheiner P
Department of Gastroenterology, Otto-von-Guericke-University Magdeburg, 39120 Magdeburg, Germany.
Aliment Pharmacol Ther. 2005 Apr 1;21(7):813-20. doi: 10.1111/j.1365-2036.2005.02425.x.
Dyspepsia is common in gastric cancer, but also in many benign conditions. European Helicobacter pylori Study Group and American Gastroenterological Association guidelines recommend endoscopy in dyspepsia for patients with alarm symptoms or at age >45 years. However, recommendations are controversial.
To investigate whether criteria for endoscopy in patients with dyspepsia are adequate to detect gastric cancer.
In 215 patients at initial diagnosis of gastric adenocarcinoma, symptoms were classified as alarm and non-alarm. Cases were staged according to the TNM system. Stages T(1)-T(3)N(x)M(0) were defined as potentially curable.
Dyspepsia was present in 128 patients. Among patients with dyspepsia, 15 were < or =45 years and 41 denied alarm symptoms. The combination of both criteria excluded only three (2.3%) patients from endoscopy, but increasing the threshold to >50 and >55 years would have raised the rate of excluded patients to seven (5.5%) and 11 (8.6%). Only 53 potentially curable stages and 18 early gastric cancers occurred, but the tumour stage was not associated with dyspepsia duration, age threshold of 45 years, or alarm symptoms.
Our results support current European Helicobacter Study Group and American Gastroenterological Association criteria for endoscopy in patients with dyspepsia to detect gastric cancer. Regardless, most cancers are advanced at detection.
消化不良在胃癌中很常见，但在许多良性疾病中也存在。欧洲幽门螺杆菌研究小组和美国胃肠病学会指南建议，有报警症状或年龄>45岁的消化不良患者应进行内镜检查。然而，这些建议存在争议。
研究消化不良患者的内镜检查标准是否足以检测出胃癌。
对215例初诊为胃腺癌的患者，将症状分为报警症状和非报警症状。病例根据TNM系统进行分期。T(1)-T(3)N(x)M(0)期被定义为潜在可治愈期。
128例患者存在消化不良。在消化不良患者中，15例年龄≤45岁，41例否认有报警症状。这两个标准结合起来仅排除了3例（2.3%）患者进行内镜检查，但将年龄阈值提高到>50岁和>55岁会使被排除患者的比例分别提高到7例（5.5%）和11例（8.6%）。仅出现了53个潜在可治愈期和18例早期胃癌，但肿瘤分期与消化不良持续时间、45岁的年龄阈值或报警症状无关。
我们的结果支持欧洲幽门螺杆菌研究小组和美国胃肠病学会目前关于消化不良患者内镜检查以检测胃癌的标准。尽管如此，大多数癌症在检测时已处于晚期。
