幽门螺杆菌“检测和治疗”策略对未经调查消化不良患者处理的安全性评估

Safety of Helicobacter pylori ‘test-and-treat’ strategies for the management of uninvestigated dyspepsia

目的评价幽门螺杆菌(Hp)“检测和治疗”及“检测和内镜检查”策略在上海地区未经调查的消化不良患者处理中应用的安全性。方法回顾性调查2002-2003年在上海仁济医院内镜中心接受胃镜检查的上海本地区消化不良患者中胃、食管、十二指肠恶性肿瘤的检出率、报警症状及Hp感染情况。结果14101例消化不良患者中,检出胃、食管、十二指肠恶性肿瘤者202例(143%),其中胃癌162例(115%)、胃恶性淋巴瘤4例、食管癌35例(025%)和十二指肠癌1例。恶性肿瘤患者中Hp感染率为490%,报警症状发生率为535%。45岁以下者中检出恶性肿瘤18例(046%),均为胃癌,报警症状发生率为278%,Hp感染率为722%。如在上述无报警症状、年龄小于45岁患者中采用Hp“检测和治疗”策略,则将漏诊胃癌13例(722%),如采用Hp“检测和内镜检查”策略,则将漏诊胃癌3例(167%)。结论Hp“检测和治疗”及“检测和内镜检查”策略均不适用于上海地区未经调查消化不良患者的处理。对多数上海地区成人消化不良患者,即时内镜检查将是初始处理的首选策略。

Objective To verify the safety of Helicobacter pylori (Hp)‘test-and-treat’ and ‘test-and-endoscopy’strategies for management of uninvestigated dyspepsia in Shanghai patients. Methods ~14 101 consecutive patients presented with dyspepsia receiving endoscopy during Oct. 2002 to Dec. 2003 were retrospectively analyzed in this study. The detective rate of esophageal or gastroduodenal malignancies and alarm symptoms were investigated and Hp status was assessed. Results Total 202(1.43%)malignancies were found, including gastric cancer in 162 (1.15%), malignant gastric lymphoma in 4, esophageal cancer in 35 (0.25%) and duodenal cancer in 1. Among those patients with malignancies, ninety-nine (49.0%) patients were infected with Hp and 108 (53.5%) presented with alarm symptoms. Eighteen patients (0.46%) under the age of 45 years were diagnosed as gastric cancer. Among these patients, 5 (27.8%) presented with alarm symptoms and 13 (72.2%) were infected with Hp . If the Hp ‘test-and-treat’strategy was used in dyspeptic patients under the age of 45 years without alarm symptoms in Shanghai region, then 13 cases (72.2%) of gastric cancer would be missed. If the Hp ‘test-and-endoscopy’strategy was applied, then 3 cases (16.7%) of gastric cancer would be missed. Conclusions Hp ‘test-and-treat’and ‘test-and-endoscopy’strategies are all not suitable for the management of uninvestigated dyspepsia in Shanghai patients. For most Shanghai adult dyspeptic patients, prompt endoscopy should be recommended as the first-line initial management option.