Patel P, Khulusi S, Mendall M A, Lloyd R, Jazrawi R, Maxwell J D, Northfield T C
Department of Medicine, St George's Hospital Medical School, London, UK.
Lancet. 1995 Nov 18;346(8986):1315-8. doi: 10.1016/s0140-6736(95)92340-3.
Helicobacter pylori infection is associated with 95% of duodenal ulcers and more than 80% of gastric ulcers. Several reports have indicated that screening for H pylori may avoid subsequent endoscopic examination. We screened 183 dyspeptic patients, aged under 45, by taking a history of sinister symptoms and regular use of non-steroidal anti-inflammatory drugs (NSAIDs), together with serological testing for H pylori. Endoscopy was performed on 113 patients, of whom 90 (49%) were seropositive, 14 (8%) had sinister symptoms, and 9 (5%) had used NSAIDs regularly. In 34 (19%) patients we detected peptic ulceration. The remaining 70 (38%) patients who were H pylori seronegative, had no sinister symptoms, and had not taken NSAIDs (screen-negative), did not undergo endoscopy but were returned to their primary care physician for treatment of symptoms. At subsequent reassessment (of the non-endoscoped group), symptom severity (p = 0.002), interference with life events (p = 0.01), and medication (p = 0.0002) were all significantly lower in the 6 months after screening than in the 6 month period before screening. Only three screen-negative patients were re-referred after screening but their endoscopic findings were normal. Thus, 67 (36%) endoscopies were avoided. When the non-endoscoped screen-negative patients were compared with a cohort of endoscoped screen-negative patients, the groups did not differ in terms of symptom severity (odds ratio 1.12, 95% CI 0.53-2.35, p = 0.77) or interference with life events (0.82, 0.38-1.76, p-0.61). However, medication use was significantly less (0.37, 0.17-0.80, p = 0.01) in those who did not have an endoscopy. Our study indicates that colonisation screening based on H pylori serology, a history of sinister symptoms, or a history of NSAID use was worthwhile in dyspeptic patients. We avoided 37% of endoscopies and reduced drug usage without disadvantaging those not endoscoped.
幽门螺杆菌感染与95%的十二指肠溃疡和80%以上的胃溃疡相关。多项报告表明，筛查幽门螺杆菌可避免后续的内镜检查。我们对183名45岁以下的消化不良患者进行了筛查，询问其是否有严重症状及是否经常使用非甾体抗炎药（NSAIDs），并进行幽门螺杆菌血清学检测。对113名患者进行了内镜检查，其中90名（49%）血清呈阳性，14名（8%）有严重症状，9名（5%）经常使用NSAIDs。在34名（19%）患者中检测到消化性溃疡。其余70名（38%）幽门螺杆菌血清学阴性、无严重症状且未服用NSAIDs（筛查阴性）的患者未接受内镜检查，而是回到他们的初级保健医生处接受症状治疗。在随后的重新评估（针对未接受内镜检查的组）中，与筛查前6个月相比，筛查后6个月的症状严重程度（p = 0.002）、对生活事件的干扰（p = 0.01）以及药物使用（p = 0.0002）均显著降低。筛查后只有3名筛查阴性的患者被再次转诊，但他们的内镜检查结果正常。因此，避免了67例（36%）内镜检查。当将未接受内镜检查的筛查阴性患者与一组接受内镜检查的筛查阴性患者进行比较时，两组在症状严重程度（比值比1.12，95%可信区间0.53 - 2.35，p = 0.77）或对生活事件的干扰（0.82，0.38 - 1.76，p = 0.61）方面没有差异。然而，未进行内镜检查的患者药物使用显著减少（0.37，0.17 - 0.80，p = 0.01）。我们的研究表明，基于幽门螺杆菌血清学、严重症状史或NSAIDs使用史的定植筛查对消化不良患者是值得的。我们避免了37%的内镜检查，并减少了药物使用，且对未接受内镜检查的患者没有不利影响。
