The serological gastric biopsy in primary care : studies on atrophic gastritis
Korstanje, A.
Citation
Korstanje, A. (2006, June 26). The serological gastric biopsy in primary care : studies on atrophic gastritis. Retrieved from https://hdl.handle.net/1887/4443
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Chapter I I
One cannot be medically literate
w ith ou t th e f lu ency in th e lang u ag e of science.
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31- Chapter II
Character, aims and outline of the thesis
C h a r a c t e r o f t h e t h e s i s
T he c harac ter o f this thes is is in a w ay u n iq u e that all the s tu d ies o n atro phic g as - tritis are perfo rm ed in an u n s elec ted as y m pto m atic po pu latio n at the prim ary c are lev el. T he s tu d y po pu latio n is a s am ple o f the in hab itan ts o f s ev eral ru ral v illag es o n Z u id - B ev elan d , the m id d le pen in s u la o f the D u tc h pro v in c e Z eelan d . T his reg io n has a fairly s tab le res id en t po pu latio n w ith pred o m in an tly in d ig en o u s peo ple an d is therefo re an appro priate area fo r epid em io lo g ic al in v es tig atio n . A ll s tu d y s u b jec ts w ere rec ru ited ju s t fro m o n e g en eral prac tic e. T he s tu d ies hav e an ex plo rativ e c har- ac ter an d n o s am ple s iz e an d s tatis tic al po w er c alc u latio n w as u s ed . It is d em o n s trated ho w the g en eral prac titio n er c an c arry o u t s tu d ies in his o w n prac tic e o n a s c ien tific b as e, c o n trib u tin g to a d eeper u n d ers tan d in g o f health c are q u es tio n s . .
A i m s o f t h e t h e s i s
T he s tu d ies in c lu d ed in this thes is aim to c o n trib u te to the k n o w led g e in prim ary c are o f 1 . the s ero epid em io lo g ic al an d aetio lo g ic al as pec ts o f atro phic c o rpu s g as tritis in
a prim ary health c are c o m m u n ity
2 . the reliab ility o f1 3C- u rea b reath tes t fo r the pres en c e o f H. pylori in fec tio n in pa- tien ts w ith atro phic c o rpu s g as tritis
3 . a n o v el n o n - in v as iv e s tim u latio n tes t fo r the d iag n o s is o f the d eg ree o f g as tric b o d y atro phy
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Chapter II
A search of the literature on atrophic gastritis will turn up no primary care research activity into this subject. M ost of what we know about how to diagnose and survey chronic atrophic gastritis is derived from the expert opinion of specialists and from research generated in secondary and tertiary care setting. M ost importantly, sec- ondary and tertiary care research involves selected patient populations for whom the probability of disease and outcome may be different from what we encounter in the frontline primary care practice.
O u t l i n e o f t h e t h e s i s
The introductive Chapter 1 invites the interested and critical reader to take know- ledge of the background of the serum profile of gastric mucosa in relation to his- tological diagnosis of atrophy. This general introductive overview provides essen- tial current information for complete understanding of the research described in this thesis.
Chapter 2 comprises the character, aims and outline of this thesis
In Chapter 3 the question is investigated whether the gastric serum biopsy might be useful as a diagnostic tool in management of the dyspeptic patient in primary care.
W e survey the literature on this subject and try to formulate a recommendation for the clinical application of the gastric serum profile as non-invasive first-pass marker of gastric disease.
In Chapter 4 the seroprevalence of atrophic corpus gastritis, a risk factor for gastric cancer, is assessed in the general Dutch autochtonous population. A community based explorative study by serology is performed in a large primary cohort of 9 9 7 consecutive subjects. In addition, the involvement of H. pylori infection and gastric autoimmunity in serological atrophic corpus gastritis is studied.
Chapter 5 explores the diagnostic accuracy of gastric serum profile in relation to en- doscopical and histological diagnosis of gastric body atrophy. Cancer risk is di- rectly correlated with the severity and extent of mucosal atrophy, making identifi- cation of atrophy a goal in cancer prevention programs. The study population comprises asymptomatic subjects with serological atrophic corpus gastritis, se- lected from the large primary cohort of 9 9 7 primary care subjects on the basis of the serum profile of gastric body atrophy.
Chapter 6 evaluates the detection of H. pylori infection with 13Carbon urea breath test in subjects with asymptomatic atrophic corpus gastritis. The few available data based on selected patients point to limited value of the 13C-U BT in atrophic con-
ditions of the stomach. However, such information may not be applicable to ge- neral practice. In this study the diagnostic accuracy of13C-UBT for H. pylori in- fection is compared to biopsy, culture and serology in 20 asymptomatic primary care patients with histologically proven gastric body atrophy.
In Chapter 7 a novel non-invasive stimulation test in the diagnosis of the degree of atrophic body gastritis is presented. P roton pump inhibitors ( P P Is) are known to be potent pepsinogen and gastrin releasing drugs. The effect of short-term admini- stration of a P P I on the serum concentration of pepsinogen A and gastrin is eval- uated in asymptomatic subjects with serological atrophic corpus gastritis. O ur premise is that P P I-stimulated pepsinogen A in subjects with putative gastric body atrophy has an inverse graded relation with atrophy.
In Chapter 8 we try to gain insight in the possible involvement of H. pylori infection in the development of the atrophic gastritis characteristic of pernicious anaemia.
O vert pernicious anaemia is usually H. pylori negative. The pre-pernicious stage of gastritis would be a desirable period to test for H. pylori infection. Therefore the seroprevalence of H. pylori infection and atrophic corpus gastritis is studied in first and second degree relatives of patients with pernicious anaemia and compared with the seroprevalence in relatives of patients with hypertension, a disorder which is known to be as a rule not related to H. pylori infection.
In Chapter 9 the results of the various studies presented in this thesis are summa- rized and commented.
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Character, aims and outline of the thesis
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