Qureshi Nafees A, Hallissey Michael T, Fielding John W
Department of upper GI surgery, University Hopitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham B15 2TH, UK.
BMC Gastroenterol. 2007 Nov 22;7:43. doi: 10.1186/1471-230X-7-43.
Patients with malignant tumours of the upper gastrointestinal tract tumours exhibit important alarm symptoms such as dysphagia that warrant clinical investigations. An endoscopic examination of the upper gastrointestinal tract will be required in most cases. This study evaluates the diagnostic potential of index endoscopy in a random population of patients with dysphagia.
This is a retrospective analysis of prospectively collected data over 10 years. Patients with previous endoscopic evaluation or upper gastrointestinal pathology were excluded from the study. Data was analysed to see the number and frequency of abnormal findings in upper gastrointestinal tract, and their significance in relation to the presenting symptoms.
Total number of index endoscopies was 13, 881. 913 patients were included in the study including 465 males (age range: 17-92 years, median: 55 years) and 448 females (age range: 18-100, median: 59 years), with male to female ratio of 1.04: 1. Oesophagus was abnormal in 678 cases (74%) and biopsies were taken in 428 patients (47%). Superficial oesophagitis, Barrett's oesophagus, oesophageal cancer, and oesophageal ulcer were main histological findings. Age more than 50 years and weight loss were significant predictors of oesophageal cancer (p < 0.0001). Male gender, heartburn, epigastric pain, weight loss and vomiting were significantly related to Barrett's oesophagus. A total of 486 gastric and 56 duodenal biopsies were also taken. There were 20 cases of gastric adenocarcinoma.
OGD is an effective initial investigation to assess patients with dysphagia, especially males above the age of 50 years. Patients may be started on treatment or referred for further investigations, for example, a barium meal in the absence of any anatomical abnormality.
上消化道恶性肿瘤患者会出现诸如吞咽困难等重要警示症状，这需要进行临床检查。大多数情况下需要对上消化道进行内镜检查。本研究评估了索引内镜检查在随机选取的吞咽困难患者群体中的诊断潜力。
这是一项对前瞻性收集的长达10年的数据进行的回顾性分析。曾接受过内镜评估或有上消化道病变的患者被排除在研究之外。分析数据以查看上消化道异常发现的数量和频率，以及它们与所呈现症状的相关性。
索引内镜检查总数为13881例。913例患者纳入研究，其中男性465例（年龄范围：17 - 92岁，中位数：55岁），女性448例（年龄范围：18 - 100岁，中位数：59岁），男女比例为1.04:1。678例（74%）食管有异常，428例（47%）患者进行了活检。浅表性食管炎、巴雷特食管、食管癌和食管溃疡是主要的组织学发现。年龄超过50岁和体重减轻是食管癌的显著预测因素（p < 0.0001）。男性、烧心、上腹部疼痛、体重减轻和呕吐与巴雷特食管显著相关。还进行了486例胃活检和56例十二指肠活检。有20例胃腺癌。
上消化道内镜检查是评估吞咽困难患者的有效初始检查方法，尤其是50岁以上的男性。在没有任何解剖学异常的情况下，可开始对患者进行治疗或转诊进行进一步检查，例如钡餐检查。
