Gastroenterology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.
Pathology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.
J Gastrointestin Liver Dis. 2021 Feb 12;30(1):25-29. doi: 10.15403/jgld-2952.
In clinical practice, most patients with symptoms suggestive of gastroesophageal reflux disease (GERD) undergo esophago-gastro-duodenoscopy (EGD), despite its low sensitivity in detecting reflux stigmata. Gastrin 17 (G-17) has been proposed to be related with GERD, due to the negative feedback between acid secretion and this hormone. We assessed the clinical usefulness of fasting G-17 serum determination for a non-invasive diagnosis of GERD in patients with typical symptoms.
We consecutively enrolled patients complaining of typical GERD symptoms in two different settings: a single referral center and a primary care setting. Control groups consisted of dyspeptic patients. All subjects underwent assessment of serum levels of G-17 and EGD.
At the academic hospital, 100 GERD patients (n=89 with erosive esophagitis and 11 with Barrett's esophagus) had statistically significant low levels of G-17 as compared with 184 dyspeptic patients (1.7±1.2 pg/L vs 8.9±5.7 pg/L p<0.0001). Similarly, in the primary care setting, 163 GERD patients had statistically significant low levels of G-17 as compared with 132 dyspeptic patients (0.5±0.2 pg/L vs. 4.0±2.6 pg/L, p<0.0001). Moreover, in the primary care setting, no statistically significant differences were found for G-17 levels between patients with erosive and non-erosive reflux pattern (0.4±0.2 vs 0.7±0.3; p=0.08). In primary care, the accuracy of G-17 less than 1 pg/L to diagnose non-invasively GERD was 94.3%.
Low levels of G-17 were detected in patients with erosive esophagitis and Barrett's esophagus in a referral center and in patients with typical GERD symptoms in a sample of patients from a primary care setting.
在临床实践中，大多数有胃食管反流病（GERD）症状的患者都接受了食管胃十二指肠镜检查（EGD），尽管其在检测反流迹象方面的敏感性较低。由于胃酸分泌与这种激素之间的负反馈关系，胃泌素 17（G-17）被认为与 GERD 有关。我们评估了空腹血清 G-17 测定在具有典型症状的 GERD 患者中的非侵入性诊断中的临床应用价值。
我们连续招募了在两个不同环境中出现典型 GERD 症状的患者：一个是单一转诊中心，另一个是初级保健环境。对照组由消化不良患者组成。所有患者均接受血清 G-17 水平评估和 EGD 检查。
在学术医院，100 名 GERD 患者（89 名患有糜烂性食管炎，11 名患有 Barrett 食管）的 G-17 水平明显低于 184 名消化不良患者（1.7±1.2 pg/L 比 8.9±5.7 pg/L，p<0.0001）。同样，在初级保健环境中，163 名 GERD 患者的 G-17 水平明显低于 132 名消化不良患者（0.5±0.2 pg/L 比 4.0±2.6 pg/L，p<0.0001）。此外，在初级保健环境中，患有糜烂性和非糜烂性反流模式的患者之间的 G-17 水平无统计学差异（0.4±0.2 vs 0.7±0.3；p=0.08）。在初级保健中，G-17 水平低于 1 pg/L 用于非侵入性诊断 GERD 的准确率为 94.3%。
在转诊中心的糜烂性食管炎和 Barrett 食管患者以及初级保健环境中具有典型 GERD 症状的患者中，发现了低水平的 G-17。
