Mosiman F, Donovan I A, Alexander-Williams J
J Clin Gastroenterol. 1985 Apr;7(2):133-6. doi: 10.1097/00004836-198504000-00006.
We have studied the accuracy of diagnostic methods in achieving a diagnosis in 75 patients with 81 proven episodes of recurrent ulceration. When the endoscopic findings did not permit an accurate diagnosis, radiology usually provided no additional information. The sensitivity of a combined diagnostic approach was not different from that of endoscopy alone, and so the routine use of upper GI radiographs in addition to endoscopy should, therefore, be abandoned. We also assessed observer variation among endoscopists prospectively in 38 patients investigated for dyspepsia after operation for peptic ulcer. Major observer variation in diagnosing suspected recurrent ulceration occurred in 11% of patients, with a sensitivity and specificity higher than 77 and 94%, respectively. As not all the postoperative gastroduodenojejunal mucosal breaches are peptic, we suggest that acid output and enterogastric reflux assessments are useful diagnostic adjuncts to endoscopy.
我们研究了诊断方法对75例患者81次确诊复发性溃疡发作进行诊断的准确性。当内镜检查结果无法做出准确诊断时，放射学检查通常也无法提供更多信息。联合诊断方法的敏感性与单纯内镜检查并无差异，因此，除内镜检查外常规使用上消化道造影应予以摒弃。我们还对38例因消化性溃疡手术后消化不良接受检查的患者进行了内镜医师之间观察差异的前瞻性评估。11%的患者在诊断疑似复发性溃疡时存在主要观察差异，其敏感性和特异性分别高于77%和94%。由于并非所有术后胃十二指肠空肠黏膜破损都是消化性的，我们建议胃酸分泌和肠胃反流评估是内镜检查有用的辅助诊断方法。
