第二季案例答案公布(2011年11月26日)

第二期案例的答案公布如下,第二期案例原文在http://www.uschie.org/web/en/current/96-gi-club/1032--giclub20111010

I recommended that he have an H pylori IgG test which came back strongly positive. He received Prevpac treatment for 14 days and has been doing great for the past year without any recurrent symptoms.

H pylori infection is very common in the developing countries and senior population in the US. Up to 70% of the Chinese population over 50 has been estimated to be infected by the bacteria. It may or may not present with any symptoms but is a major cause of gastritis, peptic ulcer disease and gastric cancer. Patients usually develop symptoms such as abdominal pain or upper GI bleeding after taking NSAIDs, anticoagulants, antiplatelet agents or undergoing stressful situation. Common mistakes are made in its diagnosis. For the gastroenterologists, the diagnosis is often missed because gastric biopsies are of low yield if fewer than 5 samples are taken of the stomach and because the detection rate is even lower if the patient has been taking PPI or certain antibiotics. This is particularly true if the test is based on histology rather than enzyme test such as the CLO test or PCR. PPI and certain antibiotics also affect H pylori detection through breath test and stool antigen test. Serological test is not affected by the above caveats but IgA is less sensitive than IgG and could also yield false negative result if the patient is IgA deficient which is not uncommon in the general population. Therefore the best test for initial diagnosis of H pylori is usually blood IgG antibody. For the primary physicians, a common mistake is to recheck H pylori serology test after treatment to check for eradication of the bacteria. H pylori serology test can remain positive for many years after successful eradication and therefore should not be used to check for treatment success. For most patients who have no high risk factors such as bleeding ulcers, H pylori-induced MALT lymphoma or gastric cancer, no post-treatment check is necessary because of the high eradication rate (although in certain parts of the world, this may not be true because of high prevalence of antibiotic resistance). If post-treatment check is necessary, breath test or stool antigen test without PPI or antibiotic exposure is the correct choice.

Original Session 2 case: A53 year male Chinese cardiologist practicing in the US went back to China for a visit. In China, he had increased epigastric discomfort and burning sensation and noticed black stools on several occasions. He thought he might have peptic ulcer disease and self-treated with omeprazole for about a week and the symptoms improved. After returning to the US, he had further testing and was found to have a low hemoglobin and underwent EGD and colonoscopy including terminal ileum examination with completely normal findings. He had H pylori IgA blood test that was also negative. He did have a history of some occasional epigastric discomfort in the past but never had any serious stomach problems. But now he is more concerned about the cause of this episode of apparent GI bleeding. He asked me what he should do. What advice would you give him as a gastroenterologist?

回顾

第一期案例原文在:http://www.uschie.org/web/zh/current/96-gi-club/934--20110830

第一期案例原文与第二期案例在:http://www.uschie.org/web/en/current/96-gi-club/1032--giclub20111010

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