BACKGROUND No studies have evaluated the predictive value of alarm symptoms for organic dyspepsia and organic upper gastrointestinal(GI)diseases based on Rome IV criteria in the Chinese population.AIM To evaluate the ...BACKGROUND No studies have evaluated the predictive value of alarm symptoms for organic dyspepsia and organic upper gastrointestinal(GI)diseases based on Rome IV criteria in the Chinese population.AIM To evaluate the predictive value of alarm symptoms for dyspeptic patients based on Rome IV criteria.METHODS We performed a cross-sectional study of dyspepsia patients who met the inclusion and exclusion criteria at two academic urban tertiary-care centers from March 2018 to January 2019.Basic demographic data,dyspeptic information,alarm symptoms,lifestyle,examination results,family history and outpatient cost information were collected.Dyspepsia patients with normal findings on upper GI endoscopy,epigastric ultrasound and laboratory examination and without Helicobacter pylori-associated dyspepsia were classified as functional dyspepsia.RESULTS A total of 381 patients were enrolled in the study,including 266 functional dyspepsia patients and 115 organic dyspepsia patients.There were 24 patients with organic upper GI disease among patients with organic dyspepsia.We found that based on the Rome IV criteria,alarm symptoms were of limited value in differentiating organic dyspepsia and organic upper GI diseases from functional dyspepsia.Age(odds ratio(OR)=1.056,P=0.012),smoking(OR=4.714,P=0.006)and anemia(OR=88.270,P<0.001)were independent predictors for organic upper GI diseases.For the comparison of epigastric pain syndrome,postprandial distress syndrome and epigastric pain syndrome combined with postprandial distress syndrome,the results showed that there were statistically significant differences in anorexia(P=0.021)and previous visits(P=0.012).The ClinicalTrials.gov number is NCT 03479528.CONCLUSION Most alarm symptoms had poor predictive value for organic dyspepsia and organic upper GI diseases based on Rome IV criteria.Gastroscopic screening should not be based solely on alarm symptoms.展开更多
Biliary ascariasis is a common problem in rural areas in China.The common presentations include biliary colic,acute cholangitis,obstructive jaundice,choledocholithiasis and acute cholecystitis.Here,we describe a case ...Biliary ascariasis is a common problem in rural areas in China.The common presentations include biliary colic,acute cholangitis,obstructive jaundice,choledocholithiasis and acute cholecystitis.Here,we describe a case with biliary ascariasis two days after endoscopic sphincterotomy for choledocholithiasis.A living ascaris was successfully removed by endoscopic retrograde cholangiopancreatography.This case indicated that biliary ascariasis is not an uncommon complication of endoscopic sphincterotomy in some regions where ascariasis is epidemic.展开更多
BACKGROUND Irritable bowel syndrome(IBS)is a common functional bowel disease that shares features with many organic diseases and cannot be accurately diagnosed by symptom-based criteria.Alarm symptoms have long been a...BACKGROUND Irritable bowel syndrome(IBS)is a common functional bowel disease that shares features with many organic diseases and cannot be accurately diagnosed by symptom-based criteria.Alarm symptoms have long been applied in the clinical diagnosis of IBS.However,no study has explored the predictive value of alarm symptoms in suspected IBS patients based on the latest Rome IV criteria.AIM To investigate the predictive value of alarm symptoms in suspected IBS patients based on the Rome IV criteria.METHODS In this multicenter cross-sectional study,we collected data from 730 suspected IBS patients evaluated at 3 tertiary care centers from August 2018 to August 2019.Patients with IBS-like symptoms who completed colonoscopy during the study period were initially identified by investigators through medical records.Eligible patients completed questionnaires,underwent laboratory tests,and were assigned to the IBS or organic disease group according to colonoscopy findings and pathology results(if a biopsy was taken).Independent risk factors for organic disease were explored by logistic regression analysis,and the positive predictive value(PPV)and missed diagnosis rate were calculated.RESULTS The incidence of alarm symptoms in suspected IBS patients was 75.34%.Anemia[odds ratio(OR)=2.825,95%confidence interval(CI):1.273-6.267,P=0.011],fecal occult blood[OR=1.940(95%CI:1.041-3.613),P=0.037],unintended weight loss(P=0.009),female sex[OR=0.560(95%CI:0.330-0.949),P=0.031]and marital status(P=0.030)were independently correlated with organic disease.The prevalence of organic disease was 10.41%in suspected IBS patients.The PPV of alarm symptoms for organic disease was highest for anemia(22.92%),fecal occult blood(19.35%)and unintended weight loss(16.48%),and it was 100%when these three factors were combined.The PPV and missed diagnosis rate for diagnosing IBS were 91.67%and 74.77%when all alarm symptoms were combined with Rome IV and 92.09%and 34.10%when only fecal occult blood,unintended weight loss and anemia were combined with Rome IV,respectively.CONCLUSION Anemia,fecal occult blood and unintended weight loss have high predictive value for organic disease in suspected IBS patients and can help identify patients requiring further examination but are not recommended as exclusion criteria for IBS.展开更多
文摘BACKGROUND No studies have evaluated the predictive value of alarm symptoms for organic dyspepsia and organic upper gastrointestinal(GI)diseases based on Rome IV criteria in the Chinese population.AIM To evaluate the predictive value of alarm symptoms for dyspeptic patients based on Rome IV criteria.METHODS We performed a cross-sectional study of dyspepsia patients who met the inclusion and exclusion criteria at two academic urban tertiary-care centers from March 2018 to January 2019.Basic demographic data,dyspeptic information,alarm symptoms,lifestyle,examination results,family history and outpatient cost information were collected.Dyspepsia patients with normal findings on upper GI endoscopy,epigastric ultrasound and laboratory examination and without Helicobacter pylori-associated dyspepsia were classified as functional dyspepsia.RESULTS A total of 381 patients were enrolled in the study,including 266 functional dyspepsia patients and 115 organic dyspepsia patients.There were 24 patients with organic upper GI disease among patients with organic dyspepsia.We found that based on the Rome IV criteria,alarm symptoms were of limited value in differentiating organic dyspepsia and organic upper GI diseases from functional dyspepsia.Age(odds ratio(OR)=1.056,P=0.012),smoking(OR=4.714,P=0.006)and anemia(OR=88.270,P<0.001)were independent predictors for organic upper GI diseases.For the comparison of epigastric pain syndrome,postprandial distress syndrome and epigastric pain syndrome combined with postprandial distress syndrome,the results showed that there were statistically significant differences in anorexia(P=0.021)and previous visits(P=0.012).The ClinicalTrials.gov number is NCT 03479528.CONCLUSION Most alarm symptoms had poor predictive value for organic dyspepsia and organic upper GI diseases based on Rome IV criteria.Gastroscopic screening should not be based solely on alarm symptoms.
文摘Biliary ascariasis is a common problem in rural areas in China.The common presentations include biliary colic,acute cholangitis,obstructive jaundice,choledocholithiasis and acute cholecystitis.Here,we describe a case with biliary ascariasis two days after endoscopic sphincterotomy for choledocholithiasis.A living ascaris was successfully removed by endoscopic retrograde cholangiopancreatography.This case indicated that biliary ascariasis is not an uncommon complication of endoscopic sphincterotomy in some regions where ascariasis is epidemic.
基金Supported by the Key Research and Development Program of Shaanxi Province,No.2017ZDXMSF-046.
文摘BACKGROUND Irritable bowel syndrome(IBS)is a common functional bowel disease that shares features with many organic diseases and cannot be accurately diagnosed by symptom-based criteria.Alarm symptoms have long been applied in the clinical diagnosis of IBS.However,no study has explored the predictive value of alarm symptoms in suspected IBS patients based on the latest Rome IV criteria.AIM To investigate the predictive value of alarm symptoms in suspected IBS patients based on the Rome IV criteria.METHODS In this multicenter cross-sectional study,we collected data from 730 suspected IBS patients evaluated at 3 tertiary care centers from August 2018 to August 2019.Patients with IBS-like symptoms who completed colonoscopy during the study period were initially identified by investigators through medical records.Eligible patients completed questionnaires,underwent laboratory tests,and were assigned to the IBS or organic disease group according to colonoscopy findings and pathology results(if a biopsy was taken).Independent risk factors for organic disease were explored by logistic regression analysis,and the positive predictive value(PPV)and missed diagnosis rate were calculated.RESULTS The incidence of alarm symptoms in suspected IBS patients was 75.34%.Anemia[odds ratio(OR)=2.825,95%confidence interval(CI):1.273-6.267,P=0.011],fecal occult blood[OR=1.940(95%CI:1.041-3.613),P=0.037],unintended weight loss(P=0.009),female sex[OR=0.560(95%CI:0.330-0.949),P=0.031]and marital status(P=0.030)were independently correlated with organic disease.The prevalence of organic disease was 10.41%in suspected IBS patients.The PPV of alarm symptoms for organic disease was highest for anemia(22.92%),fecal occult blood(19.35%)and unintended weight loss(16.48%),and it was 100%when these three factors were combined.The PPV and missed diagnosis rate for diagnosing IBS were 91.67%and 74.77%when all alarm symptoms were combined with Rome IV and 92.09%and 34.10%when only fecal occult blood,unintended weight loss and anemia were combined with Rome IV,respectively.CONCLUSION Anemia,fecal occult blood and unintended weight loss have high predictive value for organic disease in suspected IBS patients and can help identify patients requiring further examination but are not recommended as exclusion criteria for IBS.
