Fraser A G, McIntosh C, Berry S, Moore L
Department of Medicine, Faculty of Medicine and Health Science, University of Auckland, Auckland.
N Z Med J. 1998 Jan 23;111(1058):11-4.
The urea breath test may have value in the initial assessment of dyspepsia in primary care. This pilot study tracks patient and general practitioner behaviour which cannot be predicted with modelling studies.
The urea breath test was made available over a period of 18 months. The test was requested when general practitioners would normally have used a trial of medication or referred for endoscopy. Patients with a positive urea breath test had early endoscopy before treatment. Patients with a negative urea breath test were treated according to symptom response. A follow-up questionnaire was given 6-24 months after the urea breath test.
Urea breath tests were requested on 249 patients; clinical notes and follow-up interview data were available for 207 patients (83%). The urea breath test was positive for 89 patients (43%); 70 were referred for endoscopy and peptic ulcer disease was found in 33 (47%). The urea breath test was negative for 118 patients; 14 were follow-up tests after previous H.pylori treatment. For the 104 patients with dyspepsia, a negative test and no previous treatment, 42% had 1 or more previous investigations for dyspepsia and 66% had dyspepsia symptoms for more than one year. During follow-up, 21 patients had endoscopy. Dyspepsia symptom scores were significantly lower at follow-up (p < 0.01). Using a global assessment, 66% had fewer symptoms, 22% same and 12% had more symptoms. The symptom improvement was greater if the duration of symptoms was less than one year (p < 0.05). Medication use did not change significantly. Twelve patients were dissatisfied with management; most of these would have preferred endoscopy.
A negative urea breath test appears to have some reassurance value. The use of the urea breath test as initial assessment for dyspespia may prevent the need for some endoscopy. Further controlled studies of breath testing compared with early endoscopy are required.
尿素呼气试验在基层医疗中对消化不良的初始评估可能具有价值。这项试点研究追踪了患者和全科医生的行为，而这些行为无法通过模型研究预测。
在18个月的时间内提供尿素呼气试验。当全科医生通常会使用药物试验或转诊进行内镜检查时，会要求进行该试验。尿素呼气试验呈阳性的患者在治疗前进行早期内镜检查。尿素呼气试验呈阴性的患者根据症状反应进行治疗。在尿素呼气试验6 - 24个月后进行随访问卷调查。
对249名患者进行了尿素呼气试验；有207名患者（83%）的临床记录和随访访谈数据可用。89名患者（43%）的尿素呼气试验呈阳性；70名患者被转诊进行内镜检查，其中33名（47%）发现患有消化性溃疡疾病。118名患者的尿素呼气试验呈阴性；14名是先前幽门螺杆菌治疗后的随访检查。对于104名消化不良且试验阴性且未接受过先前治疗的患者，42%曾有过1次或更多次针对消化不良的先前检查，66%的消化不良症状持续超过一年。在随访期间，21名患者进行了内镜检查。随访时消化不良症状评分显著降低（p < 0.01）。使用整体评估法，66%的患者症状减轻，22%的患者症状相同，12%的患者症状加重。如果症状持续时间少于一年，症状改善更明显（p < 0.05）。药物使用情况没有显著变化。12名患者对治疗管理不满意；其中大多数人更倾向于进行内镜检查。
尿素呼气试验呈阴性似乎具有一定的安心价值。将尿素呼气试验用作消化不良的初始评估可能会避免一些内镜检查的必要性。需要进一步进行与早期内镜检查相比的呼气试验对照研究。
