Conwell C F, Lyell R, Rodney W M
Department of Family Medicine, University of Tennessee, Memphis, USA.
J Fam Pract. 1995 Sep;41(3):245-9.
Helicobacter pylori is emerging as an important cause of peptic disease; however, few studies have been performed in primary care settings. This study examines the prevalence of H pylori in a population of primary care patients with refractory dyspepsia and evaluates the usefulness of currently available H pylori tests.
Consecutive patients with dyspepsia refractory to standard therapy were studied by endoscopy and tested for the presence of H pylori by means of four methods: office-based serology testing on endoscopically obtained specimens (CLO test), reference laboratory serology testing, rapid urease testing, and histologic diagnosis using special staining techniques.
Among 41 patients with refractory dyspepsia, 19 (46%) were serology-positive, indicating past infection with H pylori. When compared with the reference laboratory standard, office-based serology testing had a sensitivity of 87% and a specificity of 100%. Using special stains on specimens obtained by biopsy, active H pylori infection was detected in 14 (34%) patients. Using special stains as a biopsy standard, the CLO test had a sensitivity of 93% and a specificity of 93%.
Family physicians should consider adding H pylori eradication strategies to the treatment of patients with refractory dyspepsia. The rapid urease (CLO) test may be a useful adjunct for office-based family physicians who perform esophagogastroduodenoscopy. Serology alone is associated with a high false-positive rate due to past infection without active disease.
幽门螺杆菌正逐渐成为消化性疾病的一个重要病因；然而，在基层医疗环境中开展的研究较少。本研究调查了基层医疗中难治性消化不良患者群体中幽门螺杆菌的患病率，并评估了目前可用的幽门螺杆菌检测方法的实用性。
对标准治疗无效的消化不良连续患者进行内镜检查，并通过四种方法检测幽门螺杆菌的存在：对内镜获取的标本进行门诊血清学检测（CLO试验）、参考实验室血清学检测、快速尿素酶检测以及使用特殊染色技术进行组织学诊断。
在41例难治性消化不良患者中，19例（46%）血清学呈阳性，表明既往感染过幽门螺杆菌。与参考实验室标准相比，门诊血清学检测的敏感性为87%，特异性为100%。对活检获取的标本使用特殊染色，在14例（34%）患者中检测到活动性幽门螺杆菌感染。以特殊染色作为活检标准，CLO试验的敏感性为93%，特异性为93%。
家庭医生应考虑在难治性消化不良患者的治疗中增加幽门螺杆菌根除策略。快速尿素酶（CLO）试验对于进行食管胃十二指肠镜检查的门诊家庭医生可能是一种有用的辅助手段。仅血清学检测因既往感染而非活动性疾病导致假阳性率较高。
