Li Xiao-bo, Liu Wen-zhong, Ge Zhi-zheng, Chen Xiao-yu, Shi Yao, Xiao Shu-dong
Department of Gastroenterology, Shanghai Institute of Digestive Diseases, Renji Hospital, Shanghai Second Medical University, Shanghai 200001, China.
Zhonghua Nei Ke Za Zhi. 2005 Mar;44(3):195-7.
To verify the safety of Helicobacter pylori (Hp) 'test-and-treat' and 'test-and-endoscopy' strategies for management of uninvestigated dyspepsia in Shanghai patients.
14,101 consecutive patients presented with dyspepsia receiving endoscopy during Oct. 2002 to Dec. 2003 were retrospectively analyzed in this study. The detective rate of esophageal or gastroduodenal malignancies and alarm symptoms were investigated and Hp status was assessed.
Total 202 (1.43%) malignancies were found, including gastric cancer in 162 (1.15%), malignant gastric lymphoma in 4, esophageal cancer in 35 (0.25%) and duodenal cancer in 1. Among those patients with malignancies, ninety-nine (49.0%) patients were infected with Hp and 108 (53.5%) presented with alarm symptoms. Eighteen patients (0.46%) under the age of 45 years were diagnosed as gastric cancer. Among these patients, 5 (27.8%) presented with alarm symptoms and 13 (72.2%) were infected with Hp. If the Hp 'test-and-treat'strategy was used in dyspeptic patients under the age of 45 years without alarm symptoms in Shanghai region, then 13 cases (72.2%) of gastric cancer would be missed. If the Hp 'test-and-endoscopy' strategy was applied, then 3 cases (16.7%) of gastric cancer would be missed.
Hp 'test-and-treat' and 'test-and-endoscopy' strategies are all not suitable for the management of uninvestigated dyspepsia in Shanghai patients. For most Shanghai adult dyspeptic patients, prompt endoscopy should be recommended as the first-line initial management option.
验证幽门螺杆菌（Hp）“检测与治疗”及“检测与内镜检查”策略用于上海地区未经检查的消化不良患者管理的安全性。
本研究回顾性分析了2002年10月至2003年12月期间连续14101例因消化不良接受内镜检查的患者。调查食管或胃十二指肠恶性肿瘤的检出率及报警症状，并评估Hp状态。
共发现202例（1.43%）恶性肿瘤，其中胃癌162例（1.15%）、胃恶性淋巴瘤4例、食管癌35例（0.25%）、十二指肠癌1例。在这些恶性肿瘤患者中，99例（49.0%）感染了Hp，108例（53.5%）有报警症状。18例45岁以下患者被诊断为胃癌。在这些患者中，5例（27.8%）有报警症状，13例（72.2%）感染了Hp。如果在上海地区45岁以下无报警症状的消化不良患者中采用Hp“检测与治疗”策略，那么将漏诊13例（72.2%）胃癌。如果采用Hp“检测与内镜检查”策略，那么将漏诊3例（16.7%）胃癌。
Hp“检测与治疗”及“检测与内镜检查”策略均不适用于上海地区未经检查的消化不良患者的管理。对于大多数上海成年消化不良患者，应推荐及时进行内镜检查作为一线初始管理选择。
