Dakubo J C, Clegg-Lamptey J N, Sowah P
Department of Surgery, University of Ghana Medical School, P. O. Box 4236. Accra. Ghana.
West Afr J Med. 2011 Sep-Oct;30(5):342-7.
Uncomplicated dyspepsia has a low predictive value in diagnosing upper gastrointestinal organic disease making early endoscopy essential.
To assess the reliability of clinical information in the diagnosis of organic disease in patients referred for upper gastrointestinal endoscopy.
Patients who were referred for gastroscopy to the Korle Bu Teaching Hospital, in Accra between January and December, 2008 were interviewed and evaluated for this study. The patients' clinical data were correlated with the endoscopic findings to determine how appropriate the referrals were, based on the clinical information.
One thousand, six hundred and forty three patients were studies of whom 372 presented with alarm symptoms. Uncomplicated dyspepsia was the principal presenting symptom in 1271 patients. Overall, 522 (31.8%) patients had organic disease, 440 (26.8%) inflammatory conditions and 681 (41.4%) were negative endoscopies. Two hundred and nine (56.2%) patients with alarm symptoms and 313 (24.6%) without alarm symptoms (p value, OR, 95% CI; <0.001, 3.92, 3.083-5.00) had organic disease. Presentations with bleeding and suspicion of malignancy showed statistical significance with the finding of organic disease while anaemia did not. Dyspepsia was strongly associated with negative endoscopy, 84% vrs 60%, p value <0.001. Gastric malignancies were associated with age 50 years and above. The three common benign diseases of peptic ulcer, gastric ulcer and gastritis showed strong similarity in presentation and were unpredictable clinically.
Patients referred for endoscopy were young in whom there was a high prevalence of organic disease which were mostly benign.
单纯性消化不良对诊断上消化道器质性疾病的预测价值较低，因此早期内镜检查至关重要。
评估上消化道内镜检查转诊患者中临床信息对器质性疾病诊断的可靠性。
对2008年1月至12月转诊至阿克拉科勒布教学医院进行胃镜检查的患者进行访谈和评估。将患者的临床数据与内镜检查结果相关联，以根据临床信息确定转诊的合适程度。
共研究了1643例患者，其中372例有报警症状。1271例患者以单纯性消化不良为主要症状。总体而言，522例（31.8%）患者患有器质性疾病，440例（26.8%）为炎症性疾病，681例（41.4%）内镜检查为阴性。209例（56.2%）有报警症状的患者和313例（24.6%）无报警症状的患者（p值、OR、95%CI；<0.001，3.92，3.083 - 5.00）患有器质性疾病。有出血表现和怀疑恶性肿瘤与器质性疾病的发现具有统计学意义，而贫血则无。消化不良与内镜检查阴性密切相关，分别为84%对60%，p值<0.001。胃恶性肿瘤与50岁及以上年龄相关。消化性溃疡、胃溃疡和胃炎这三种常见的良性疾病在表现上有很强的相似性，临床上难以预测。
接受内镜检查转诊的患者较为年轻，其中器质性疾病的患病率较高，且大多为良性。
