Gimeno L, Valdepérez J, Macipe R, Arruga C, Cabrera T, Gomollón F
Centro de Salud Actur Sur, Hospital Miguel Servet, Zaragoza.
Rev Esp Enferm Dig. 1996 Nov;88(11):753-6.
To evaluate which clinical data are useful to select those patients with peptic ulcers in primary care most likely to benefit from complementary studies.
This is a prospective study done on 101 patients evaluated in a period of a year in a Primary Care Center. In all patients an endoscopy was done when a peptic ulcer was considered a possibility. In all cases a standardized questionnaire was completed before endoscopy and the patient evaluated by his primary care physician. The final diagnosis was defined according to endoscopy, done by expert endoscopists within seven days of the clinical evaluation. Statistical analysis was undertaken with SPSS software.
An active peptic ulcer was found in 45 (44.5%) cases. A high-grade MALT lymphoma was diagnosed in one case. Male sex, smoking status, number of cigarettes, smoking-index, and a previous history of ulcer complications were significantly associated with the diagnosis, as well as severe diurnal or nocturnal pain. Mean age was lower in ulcer patients. However no clinical data in individual or combined form did show any predictive value.
Clinical data do not permit to obviate endoscopy as the key initial procedure to diagnosis, even in primary care.
评估哪些临床数据有助于在初级保健中选择最有可能从辅助检查中获益的消化性溃疡患者。
这是一项对一家初级保健中心一年内评估的101例患者进行的前瞻性研究。当考虑可能存在消化性溃疡时，对所有患者均进行了内镜检查。所有病例在进行内镜检查前均完成了一份标准化问卷，并由其初级保健医生对患者进行评估。最终诊断根据内镜检查结果确定，由专家内镜医师在临床评估后7天内完成。使用SPSS软件进行统计分析。
45例（44.5%）发现有活动性消化性溃疡。1例诊断为高级别黏膜相关淋巴组织淋巴瘤。男性、吸烟状况、吸烟数量、吸烟指数、既往溃疡并发症史以及严重的日间或夜间疼痛与诊断显著相关，溃疡患者的平均年龄较低。然而，单独或综合形式的临床数据均未显示出任何预测价值。
即使在初级保健中，临床数据也不能免除内镜检查作为诊断的关键初始程序。
