Real-Time Gastric Juice Analysis in Cirrhotic Patients: Can We Avoid Unrewarding Gastric Biopsies?

IF 1 Q4 GASTROENTEROLOGY & HEPATOLOGY

GE Portuguese Journal of Gastroenterology Pub Date : 2024-09-23 eCollection Date: 2025-04-01 DOI:10.1159/000540698

Sergio Peralta, Vincenza Calvaruso, Francesca Di Giorgio, Marco Peralta, Vincenzo Di Martino, Ada Maria Florena, Angelo Zullo

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引用次数: 0

Abstract

Background: To search for H. pylori infection and gastric precancerous lesions in cirrhotic patients is worthwhile when considering the high incidence of peptic ulcers and gastric cancer in these patients. We tested if gastric juice analysis allows to avoid unrewarding gastric biopsies.

Methods: This prospective study enrolled consecutive patients with liver cirrhosis who underwent upper endoscopy with standard gastric biopsies. Real-time gastric juice analysis was performed with a specific device (EndoFaster^®) that test ammonium concentration for H. pylori diagnosis, and pH values to suspect extensive atrophy/metaplasia involving gastric body mucosa. Sensitivity, specificity, positive predictive value, negative predictive value (NPV), the overall accuracy, and the likelihood ratio were calculated for both H. pylori infection and extensive precancerous lesions on gastric mucosa.

Results: A total of 78 cirrhotic patients (males: 55; mean age: 66 ± 12 years) were enrolled. When considering as positive EndoFaster^® results when at least one of two (ammonium and pH levels) tests were positive, the NPVs were as high as 89% and 86%, respectively, to rule out H. pylori and extensive precancerous lesions on gastric mucosa, with an overall accuracy of 83% and 74%.

Conclusions: This study supports the evidence that real-time gastric juice analysis allows to avoid clinically unrewarding and potentially unsafe gastric biopsies in a definite portion of cirrhotic patients, but more data are needed.

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背景：考虑到肝硬化患者消化性溃疡和胃癌的高发病率，在这些患者中寻找幽门螺杆菌感染和胃癌前病变是值得的。我们测试了胃液分析是否可以避免无意义的胃活检：这项前瞻性研究招募了连续接受上内镜检查和标准胃活检的肝硬化患者。使用特定设备（EndoFaster®）进行实时胃液分析，检测铵浓度以诊断幽门螺杆菌，检测pH值以怀疑胃体粘膜广泛萎缩/增生。计算了幽门螺杆菌感染和胃黏膜广泛癌前病变的敏感性、特异性、阳性预测值、阴性预测值（NPV）、总体准确性和似然比：共纳入 78 名肝硬化患者（男性：55 名；平均年龄：66 ± 12 岁）。如果将两项检测（氨和 pH 值）中至少一项呈阳性的 EndoFaster® 结果视为阳性，则排除幽门螺杆菌感染和胃黏膜广泛癌前病变的 NPV 分别高达 89% 和 86%，总体准确率分别为 83% 和 74%：这项研究证明，实时胃液分析可以避免对一定比例的肝硬化患者进行无临床价值和潜在不安全的胃活检，但还需要更多的数据支持。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

GE Portuguese Journal of Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

1.60

自引率

11.10%

发文量

审稿时长

21 weeks

期刊介绍： The ''GE Portuguese Journal of Gastroenterology'' (formerly Jornal Português de Gastrenterologia), founded in 1994, is the official publication of Sociedade Portuguesa de Gastrenterologia (Portuguese Society of Gastroenterology), Sociedade Portuguesa de Endoscopia Digestiva (Portuguese Society of Digestive Endoscopy) and Associação Portuguesa para o Estudo do Fígado (Portuguese Association for the Study of the Liver). The journal publishes clinical and basic research articles on Gastroenterology, Digestive Endoscopy, Hepatology and related topics. Review articles, clinical case studies, images, letters to the editor and other articles such as recommendations or papers on gastroenterology clinical practice are also considered. Only articles written in English are accepted.