Peralta Sergio, Calvaruso Vincenza, Di Giorgio Francesca, Peralta Marco, Di Martino Vincenzo, Florena Ada Maria, Zullo Angelo
Gastroenterology and Hepatology Section, Department of Internal Medicine, University of Palermo, Palermo, Italy.
Gastroenterology and Endoscopy, "Nuovo Regina Margherita" Hospital, Rome, Italy.
GE Port J Gastroenterol. 2024 Sep 23;32(2):118-123. doi: 10.1159/000540698. eCollection 2025 Apr.
To search for infection and gastric precancerous lesions in cirrhotic patients is worthwhile when considering the high incidence of peptic ulcers and gastric cancer in these patients. We tested if gastric juice analysis allows to avoid unrewarding gastric biopsies.
This prospective study enrolled consecutive patients with liver cirrhosis who underwent upper endoscopy with standard gastric biopsies. Real-time gastric juice analysis was performed with a specific device (EndoFaster) that test ammonium concentration for diagnosis, and pH values to suspect extensive atrophy/metaplasia involving gastric body mucosa. Sensitivity, specificity, positive predictive value, negative predictive value (NPV), the overall accuracy, and the likelihood ratio were calculated for both infection and extensive precancerous lesions on gastric mucosa.
A total of 78 cirrhotic patients (males: 55; mean age: 66 ± 12 years) were enrolled. When considering as positive EndoFaster results when at least one of two (ammonium and pH levels) tests were positive, the NPVs were as high as 89% and 86%, respectively, to rule out and extensive precancerous lesions on gastric mucosa, with an overall accuracy of 83% and 74%.
This study supports the evidence that real-time gastric juice analysis allows to avoid clinically unrewarding and potentially unsafe gastric biopsies in a definite portion of cirrhotic patients, but more data are needed.
鉴于肝硬化患者消化性溃疡和胃癌的高发病率，在这些患者中寻找感染和胃癌前病变是很有必要的。我们测试了胃液分析是否能避免不必要的胃活检。
这项前瞻性研究纳入了连续的肝硬化患者，这些患者接受了标准胃活检的上消化道内镜检查。使用一种特定设备（EndoFaster）进行实时胃液分析，该设备检测铵浓度用于诊断，并检测pH值以怀疑胃体黏膜存在广泛萎缩/化生。计算了胃黏膜感染和广泛癌前病变的敏感性、特异性、阳性预测值、阴性预测值（NPV）、总体准确性和似然比。
共纳入78例肝硬化患者（男性55例；平均年龄：66±12岁）。当将两项检测（铵和pH水平）中至少一项呈阳性时的EndoFaster结果视为阳性时，排除胃黏膜感染和广泛癌前病变的NPV分别高达89%和86%，总体准确性分别为83%和74%。
本研究支持以下证据，即实时胃液分析能够在一定比例的肝硬化患者中避免临床意义不大且可能不安全的胃活检，但仍需要更多数据。
