Gastroenterology Unit, Gastroenterologia ed Endoscopia Digestiva, 'Nuovo Regina Margherita' Hospital, Via Emilio Morosini, 30, Rome 00153 , Italy.
Gastroenterology and Digestive Endoscopy Unit, 'San Martino' Hospital, Belluno, Italy.
Dig Liver Dis. 2022 Dec;54(12):1646-1648. doi: 10.1016/j.dld.2022.06.014. Epub 2022 Jul 3.
In patients with atrophic gastritis involving gastric body mucosa the pH value of gastric juice is distinctly increased, so that pH assessment would allow predict this precancerous lesion. We tested whether EndoFaster® - a device allowing real-time pH measure and H. pylori diagnosis - may optimize the need of taking gastric biopsies.
In this prospective, multicentre study, the accuracy of EndoFaster® for ruling out gastric atrophy involving corporal mucosa was assessed. Real-time pH and ammonium determination was performed by aspirating 3-6 ml gastric juice during endoscopy. Histology performed on 5 standard gastric biopsies was used as gold standard.
A total of 1008 consecutive patients were observed in 12 centres. At histology, gastric body mucosa atrophy/metaplasia was detected in 65 (6.4%) cases, and a pH value >4.5 in the gastric juice was observed in 150 patients. The values of EndoFaster® performance in predicting the presence of atrophic gastritis were as follow: 51% sensitivity, 84% specificity, 18% PPV, 96% NPV, and 82% accuracy. The NPV value was not distinctly affected by neither ongoing proton pump inhibitor therapy nor H. pylori infection. By considering also data of ammonium concentrations, the values of EndoFaster® in detecting extensive atrophy on gastric mucosa were 74% sensitivity, 84% specificity, 24% PPV, 98% NPV, and 83% accuracy.
The very high NPV of EndoFaster® might allow to safely rule out presence of atrophic gastritis, reducing the need of taking gastric biopsies in unselected patients managed in clinical practice.
在胃体黏膜萎缩性胃炎患者中，胃液的 pH 值明显升高，因此 pH 值评估可以预测这种癌前病变。我们测试了 EndoFaster®——一种允许实时测量 pH 值和幽门螺杆菌诊断的设备——是否可以优化胃活检的需求。
在这项前瞻性、多中心研究中，评估了 EndoFaster®排除胃体黏膜萎缩的准确性。通过内镜抽吸 3-6ml 胃液进行实时 pH 值和氨测定。将 5 份标准胃活检组织学作为金标准。
在 12 个中心观察了 1008 例连续患者。组织学上，胃体黏膜萎缩/化生在 65 例（6.4%）中发现，胃液 pH 值>4.5 在 150 例中观察到。EndoFaster®预测萎缩性胃炎存在的性能值如下：51%的敏感性，84%的特异性，18%的阳性预测值，96%的阴性预测值和 82%的准确性。质子泵抑制剂治疗和幽门螺杆菌感染均不明显影响阴性预测值。考虑到铵浓度的数据，EndoFaster®在检测胃黏膜广泛萎缩方面的数值为 74%的敏感性，84%的特异性，24%的阳性预测值，98%的阴性预测值和 83%的准确性。
EndoFaster®非常高的阴性预测值可能允许安全排除萎缩性胃炎的存在，从而减少在临床实践中管理的未选择患者中胃活检的需求。
