A negative Helicobacter pylori serology test is more reliable for exclusion of premalignant gastric conditions than a negative test for current H-pylori infection:: A report on histology and H-pylori detection in the general adult population

被引:40
作者
Storskrubb, T [1 ]
Aro, P
Ronkainen, J
Vieth, M
Stolte, M
Wreiber, K
Engstrand, L
Nyhlin, H
Bolling-Sternevald, E
Talley, NJ
Agréus, L
机构
[1] Kalix Hosp, Dept Med, SE-95282 Kalix, Sweden
[2] Karolinska Inst, Ctr Family Med, Stockholm, Sweden
[3] Primary Hlth Care Ctr, Haparanda, Sweden
[4] Univ Magdeburg, Inst Pathol, D-39106 Magdeburg, Germany
[5] Inst Pathol, Bayreuth, Germany
[6] Inst Infect Dis Control, Stockholm, Sweden
[7] Ersta Hosp, Dept Gastroenterol, Stockholm, Sweden
[8] AstraZeneca AB, Molndal, Sweden
[9] Mayo Clin & Mayo Fdn, Div Gastroenterol & Hepatol, Rochester, MN 55905 USA
关键词
gastric mucosa/ microbiology/ pathology; gastritis/; microbiology; Helicobacter pylori; risk factors; sensitivity and specificity; serology;
D O I
10.1080/00365520410010625
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Objective. Corpus-dominant gastritis, gastric mucosal atrophy and intestinal metaplasia (IM) associated with Helicobacter pylori infection are all known potential risk markers for the development of gastric cancer. As the accuracy for finding cases at risk in the general population is unknown, we aimed to determine the prevalence of current and/or past H. pylori infection and associated gastric mucosal findings by means of histological survey of a random adult population. Material and methods. A random Swedish sample (n = 3000, age 20-81 years) was surveyed using a validated gastrointestinal symptom questionnaire with 74% response rate. One-third of the responders were selected at random for esophago-gastroduodenoscopy with biopsies and H. pylori serology. Results. Of those endoscoped (n = 1000, mean age 53.5, 51% women), 43.0% were H. pylori(+) by serology (seropositive), 33.9% had signs of current infection on either histology or culture (gold standard(+)), and 9.3% were seropositive, but gold standard negative. Corpus atrophy was found in 10% and IM in 13% when gold standard positive, and in a significantly higher number (17% and 21%, respectively) of those with only a serological sign of past infection. Among those who were seronegative, values were 1% and 2%, respectively. Corpus-dominant gastritis was found in 4.1%, all seropositive. Conclusion. One-third had an ongoing H. pylori infection, and a further 10% had signs of past infection. Corpus-dominant gastritis was found mostly among the former, while detection of those with corpus atrophy and IM also required a test for past infection. Seronegativity almost excludes precancerous conditions in a screening situation.
引用
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页码:302 / 311
页数:10
相关论文
共 52 条
[1]   SOCIOECONOMIC-FACTORS, HEALTH-CARE CONSUMPTION AND RATING OF ABDOMINAL SYMPTOM SEVERITY - A REPORT FROM THE ABDOMINAL SYMPTOM STUDY [J].
AGREUS, L .
FAMILY PRACTICE, 1993, 10 (02) :152-163
[2]  
Agréus L, 1998, ANNU REV MED, V49, P475
[3]  
Agreus Lars, 1993, Scandinavian Journal of Primary Health Care, V11, P252, DOI 10.3109/02813439308994840
[4]  
Akre K, 2000, CANCER RES, V60, P6376
[5]  
[Anonymous], 1993, Gut, V34, P1672
[6]   Valid symptom reporting at upper endoscopy in a random sample of the Swedish adult general population:: the Kalixanda study [J].
Aro, P ;
Ronkainen, J ;
Storskrubb, T ;
Bolling-Sternevald, E ;
Carlsson, R ;
Johansson, SE ;
Vieth, M ;
Stolte, M ;
Engstrand, L ;
Talley, NJ ;
Agréus, L .
SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY, 2004, 39 (12) :1280-1288
[7]   Prevalence of gastroduodenitis and Helicobacter pylori infection in a general population sample -: Relations to symptomatology and life-style [J].
Borch, K ;
Jönsson, KÅ ;
Petersson, F ;
Redéen, S ;
Mårdh, S ;
Franzén, LE .
DIGESTIVE DISEASES AND SCIENCES, 2000, 45 (07) :1322-1329
[8]  
Delaney BC, 1998, BRIT J GEN PRACT, V48, P1481
[9]   Classification and grading of gastritis - The updated Sydney System [J].
Dixon, MF ;
Genta, RM ;
Yardley, JH ;
Correa, P ;
Batts, KP ;
Dahms, BB ;
Filipe, MI ;
Haggitt, RC ;
Haot, J ;
Hui, PK ;
Lechago, J ;
Lewin, K ;
Offerhaus, JA ;
Price, AB ;
Riddell, RH ;
Sipponen, P ;
Solcia, E ;
Watanabe, H .
AMERICAN JOURNAL OF SURGICAL PATHOLOGY, 1996, 20 (10) :1161-1181
[10]   Helicobacter pylori in gastric cancer established by CagA immunoblot as a marker of past infection [J].
Ekström, AM ;
Held, M ;
Hansson, L ;
Engstrand, L ;
Nyrén, O .
GASTROENTEROLOGY, 2001, 121 (04) :784-791