Vaira D, Holton J, Osborn J, D'Anna L, Romanos A, Falzon M, McNeil I
Department of Gastroenterology, Middlesex Hospital, London, England.
Am J Gastroenterol. 1990 Jun;85(6):701-4.
Should dyspeptic patients coming to endoscopy with "normal" findings also be biopsied? To assess this, we studied the sensitivity and specificity of endoscopic examination compared with histology, microscopic evidence of Helicobacter pylori, CP-TEST, culture, and serum IgG and IgA antibody titers to H. pylori to determine whether endoscopy and antral biopsies really are useful. One hundred seven consecutive dyspeptic patients (mean age 43 yr) were entered. Four antral biopsies were taken routinely for evaluation by histology, microscopy, CP-TEST, and culture. Serum IgG and IgA antibody levels were measured in all patients. Of symptoms, postprandial bloating was statistically more common in H. pylori-positive than in negative patients. Endoscopy had the poorest sensitivity (37.1%) and specificity (53.3%). Patients with normal endoscopic appearances but histologically confirmed gastritis had significantly higher IgG and IgA titers than the patients normal by both endoscopy and histology and without evidence of H. pylori. This study has shown that endoscopy is unhelpful in dyspeptic patients if endoscopic biopsies are not routinely taken.
前来接受内镜检查且结果“正常”的消化不良患者是否也应进行活检？为评估这一问题，我们研究了内镜检查与组织学检查、幽门螺杆菌的微观证据、CP-TEST、培养以及血清针对幽门螺杆菌的IgG和IgA抗体滴度相比的敏感性和特异性，以确定内镜检查和胃窦活检是否真的有用。纳入了107例连续的消化不良患者（平均年龄43岁）。常规采集4块胃窦活检组织，用于组织学、显微镜检查、CP-TEST和培养评估。检测了所有患者的血清IgG和IgA抗体水平。在症状方面，餐后腹胀在幽门螺杆菌阳性患者中比阴性患者在统计学上更常见。内镜检查的敏感性最差（37.1%），特异性也最差（53.3%）。内镜表现正常但组织学确诊为胃炎的患者，其IgG和IgA滴度显著高于内镜和组织学检查均正常且无幽门螺杆菌证据的患者。这项研究表明，如果不常规进行内镜活检，内镜检查对消化不良患者并无帮助。
