Fraser A G, Ali M R, McCullough S, Yeates N J, Haystead A
Department of Medicine, University of Auckland.
N Z Med J. 1996 Mar 22;109(1018):95-8.
Dyspepsia is a common symptom and some selection process for endoscopy is required. This study seeks to determine if noninvasive tests for Helicobacter pylori could be useful as a screening test to help select patients for endoscopy.
Consecutive patients attending for upper gastrointestinal endoscopy were interviewed prior to endoscopy and the endoscopic diagnoses was recorded. The presence of Helicobacter pylori infection was assessed by serology. Some patients also had a 13C urea breath test or rapid urease test (CLO test).
436 consecutive patients were evaluated. The endoscopy findings were normal in 44%, 29% had reflux oesophagitis, 18% had duodenal ulcer, duodenitis or gastric ulcer and 9% had other diagnoses. 54.8% of patients were positive for Helicobacter serology. Using either the CLO test or 13C urea breath test as the confirmatory test for the diagnosis of Helicobacter pylori, the sensitivity of the serology test was 96% and 91% respectively and the specificity was 66.6 and 82%. Patients with negative serology and no history of recent NSAID or aspirin use comprised 34% of the total with dyspepsia or reflux symptoms. There were no gastric or duodenal ulcers in this group.
The serology test may have some potential or the initial evaluation of dyspepsia. These tests need to be prospectively evaluated in general practice.
消化不良是一种常见症状，需要进行一些内镜检查的筛选程序。本研究旨在确定幽门螺杆菌的非侵入性检测是否可用作筛选试验，以帮助选择进行内镜检查的患者。
对连续接受上消化道内镜检查的患者在检查前进行访谈，并记录内镜诊断结果。通过血清学评估幽门螺杆菌感染情况。部分患者还进行了13C尿素呼气试验或快速尿素酶试验（CLO试验）。
共评估了436例连续患者。内镜检查结果正常的占44%，29%有反流性食管炎，18%有十二指肠溃疡、十二指肠炎或胃溃疡，9%有其他诊断。54.8%的患者幽门螺杆菌血清学检测呈阳性。以CLO试验或13C尿素呼气试验作为诊断幽门螺杆菌的确诊试验，血清学检测的敏感性分别为96%和91%，特异性分别为66.6%和82%。血清学检测阴性且近期无非甾体抗炎药或阿司匹林使用史的患者占消化不良或反流症状患者总数的34%。该组无胃溃疡或十二指肠溃疡。
血清学检测可能对消化不良的初步评估有一定潜力。这些检测需要在全科医疗中进行前瞻性评估。
