Werdmuller B F, V/der Putten A B, Veenendaal R A, Lamers C B, Loffeld R J
Department of Internal Medicine, Ziekenhuis De Heel, Zaandam, The Netherlands.
Dig Dis Sci. 1998 Oct;43(10):2296-300. doi: 10.1023/a:1026683026028.
The objective of this study was to test the feasibility of a screening strategy for IgG antibodies against Helicobacter pylori in patients presenting with upper abdominal complaints. Biopsy specimens were taken for histological and microbiological investigations from consecutive patients undergoing upper gastrointestinal endoscopy. In addition, a serum sample was taken for detection of IgG antibodies against Helicobacter pylori, using an ELISA technique. Serum samples from 1294 consecutive patients were available. IgG antibodies against Helicobacter pylori were present in 622 patients (48%), the remaining 671 (52%) were negative. If endoscopy had been omitted in seronegative patients below the age of 45 years, this would have resulted in 234 patients not endoscoped. However, it can be assumed that 62 of these patients would undergo endoscopy because of recurrent complaints due to underlying disease or abnormality. Therefore 182 of 1294 (14%) of endoscopies would have been avoided. Application of this strategy on the total group of seronegatives would save 353 of 1294 (27.3%) endoscopies. If endoscopy had been omitted in seropositive cases below the age of 45 years, and these patients were treated with anti-Helicobacter therapy, an initial 145 endoscopies would have been avoided. However, 26 of these patients would undergo endoscopy because of persistent complaints due to underlying disease. Therefore 119 (9%) endoscopies would have been avoided. Applying this strategy in the total group of seropositives would have saved 434 of 1294 endoscopies (34%). Applying the IgG screening strategy in all patients would result in a significant number of endoscopies being avoided in the seropositive group, 434 versus 353 (P < 0.001). In conclusion, omitting endoscopy in seropositive cases, regardless of age, can reduce the workload more than omitting endoscopy in seronegative cases: 34% fewer endoscopies versus 27%.
本研究的目的是检验针对有上腹部不适症状患者的幽门螺杆菌IgG抗体筛查策略的可行性。对连续接受上消化道内镜检查的患者取活检标本进行组织学和微生物学检查。此外，采集血清样本，采用酶联免疫吸附测定（ELISA）技术检测幽门螺杆菌IgG抗体。共有1294例连续患者的血清样本可供检测。622例患者（48%）存在幽门螺杆菌IgG抗体，其余671例（52%）为阴性。如果对45岁以下血清学阴性的患者不进行内镜检查，这将导致234例患者未接受内镜检查。然而，可以假定其中62例患者会因潜在疾病或异常导致的反复不适而接受内镜检查。因此，1294例患者中有182例（14%）的内镜检查可以避免。对所有血清学阴性患者应用该策略可避免1294例中的353例（27.3%）内镜检查。如果对45岁以下血清学阳性的患者不进行内镜检查，并对这些患者进行抗幽门螺杆菌治疗，最初可避免145例内镜检查。然而，其中26例患者会因潜在疾病导致的持续不适而接受内镜检查。因此，可避免119例（9%）内镜检查。对所有血清学阳性患者应用该策略可避免1294例中的434例（34%）内镜检查。对所有患者应用IgG筛查策略将使血清学阳性组避免大量内镜检查，434例对353例（P<0.001）。总之，无论年龄如何，对血清学阳性病例不进行内镜检查比血清学阴性病例不进行内镜检查能更多地减少工作量：内镜检查减少34%对27%。
