Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China.
J Gastroenterol Hepatol. 2011 Jan;26(1):73-7. doi: 10.1111/j.1440-1746.2010.06479.x.
Gastric metaplasia (GM) of the duodenum is difficult to assess because of its patchy distribution, and the role of GM in functional dyspepsia (FD) is not clear. The aims of this study were to determine if endomicroscopy could identify GM of the duodenum and whether GM has associations with FD.
A series of 51 patients with FD and 25 asymptomatic controls were enrolled. Confocal laser endomicroscopy was performed to evaluate villi changes in vivo. Targeted biopsy specimens were then compared with histopathological results.
The accuracy of the endomicroscopy diagnosis of GM during endoscopy was 92.8%, and the sensitivity, specificity, and positive and negative predictive values were 86.2%, 97.4%, 89.3%, and 96.6%, respectively. The mean κ-value for interobserver agreement was 0.89. GM in the duodenal bulb was more frequent in patients with FD than in the controls (33.3% vs 12%, P<0.05), especially in patients with epigastric pain syndrome (47.6% vs 12%, P<0.01).
Endomicroscopy is useful for identifying GM, and GM might be related to FD. These findings could have potential applicability for duodenal screening, and suggest a possible targeting therapy in FD.
由于十二指肠化生（GM）呈斑片状分布，因此难以评估，且 GM 与功能性消化不良（FD）的关系尚不清楚。本研究旨在确定内镜下能否发现十二指肠 GM，以及 GM 是否与 FD 相关。
纳入了 51 例 FD 患者和 25 例无症状对照者。通过共聚焦激光内镜观察活体绒毛变化，然后将靶向活检标本与组织病理学结果进行比较。
内镜下 GM 的诊断准确率为 92.8%，其敏感性、特异性、阳性预测值和阴性预测值分别为 86.2%、97.4%、89.3%和 96.6%。观察者间一致性的平均κ 值为 0.89。FD 患者十二指肠球部 GM 较对照组更为常见（33.3% vs 12%，P<0.05），尤其在上腹痛综合征患者中更为常见（47.6% vs 12%，P<0.01）。
内镜下观察有助于识别 GM，且 GM 可能与 FD 相关。这些发现可能对十二指肠筛查具有潜在适用性，并提示 FD 可能具有靶向治疗的可能性。
