Endoscopic follow-up of gastric ulcer in a population at intermediate risk for gastric cancer.
OBJECTIVE
Primary: to assess the necessity of a second endoscopy with a pathology study to confirm the healing of all gastric ulcers previously diagnosed through endoscopy in a population at intermediate risk for gastric cancer. Secondary: to assess correlation between endoscopic findings and pathology diagnosis.


METHODS
a prospective analysis of patients diagnosed with gastric ulcer through endoscopy at Hospital General de Ciudad Real (Spain) over three years. We collected demographic, clinical, endoscopic, and pathological data for the first and subsequent endoscopies. We collected at least six biopsies obtained from ulcer margins, and assessed H. pylori infection.


RESULTS
Three hundred and two patients were included in this study. H. pylori infection was diagnosed in 173 (57%), and 113 (37%) patients had used NSAIDs. The positive and negative predictive value for malignancy of endoscopic diagnosis regarding ulcer fold, base, and margins were 34 and 97%, respectively. Only one patient was diagnosed with a tumor during the second endoscopy. At the end of follow-up, the etiology of the ulcer was considered as peptic in 276 patients; Crohn s disease-related in one, and neoplastic in 25 patients (21 adenocarcinomas, 4 lymphomas).


CONCLUSIONS
in an intermediate-risk population for gastric cancer a second endoscopy is not justified for gastric ulcer patients when endoscopy and biopsy results do not suggest malignancy.
Mañas
M D
MD
Service of Internal Medicine, Hospital General de Ciudad Real, Spain. meiga12@yahoo.es
Domper
A
A
Albillos
A
A
Hernández
A
A
Carpintero
P
P
Lorente
R
R
López
B
B
De la Santa
E
E
Olmedo
J
J
Rodríguez
E
E
D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D001706:Biopsy; D003424:Crohn Disease / Q000150:complications / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005756:Gastritis / Q000139:chemically induced / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000175:diagnosis / Q000453:epidemiology; D016480:Helicobacter pylori; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012306:Risk; D013030:Spain / Q000453:epidemiology; D013274:Stomach Neoplasms / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D013276:Stomach Ulcer / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000473:pathology; D019564:Unnecessary Procedures; D055815:Young Adult
D000894:Anti-Inflammatory Agents, Non-Steroidal