title: Value of real-time gastric juice analysis in upper gastrointestinal endoscopy.
abstract: OBJECTIVE
  Esophagogastroduodenoscopy (EGDS) cannot identify microscopic lesions. We determined the contribution of real-time gastric juice analysis in detecting lesions non-detectable with the simple endoscopic inspection.
  
  
  METHODS
  Endoscopy, histology and gastric juice analysis were performed in 216 patients. We assessed six diagnostic strategies: EGDS (strategy-1), EGDS with antral biopsies (hematoxylin-eosin staining) in hypochlorhydrics (strategy-2) or all patients (strategy-3), EGDS with antral and fundic biopsies (hematoxylin-eosin staining) in hypochlorhydrics (strategy-4) or all patients (strategy-5), EGDS with antral and fundic biopsies (hematoxylin-eosin + immunohistochemical staining) in hypochlorhydrics (strategy-6). Then, we determined how many of the pathological conditions identified by the complete histological evaluation would have been detected by each strategy.
  
  
  RESULTS
  In total, 220 pathological conditions were identified. Hypochlorhydria was correlated (r=0.67; P<0.01) with histological lesions (85% lesions were detected in hypochlorhydrics) and high ammonium levels, with H.pylori infection (r=0.69; P<0.01). Strategy-1 identified only 5% conditions, while strategies 3 and 5 detected 68.6% and 83.2% conditions, respectively. Strategies 2, 4 and 6 (based on gastric juice analysis) yielded detection rates (61.4%, 75.5%, 90.9%) similar to or better than those of strategies 3 and 5.
  
  
  CONCLUSIONS
  Real-time gastric juice analysis provided information about the presence of gastric lesions in an otherwise "normal" stomach at EGDS. It improved the diagnostic yield and optimized resource utilization without any additional effort by the endoscopist.
authors.affiliation: Etromapmacs Pole, Biomedical Sciences School Lesina, Foggia, Italy - aummarino@scienzebiomediche.it.
authors.forename: A
authors.initials: A
authors.lastname: Ummarino
authors.forename: F A
authors.initials: FA
authors.lastname: Tucci
authors.forename: G
authors.initials: G
authors.lastname: Pezzicoli
authors.forename: A P
authors.initials: AP
authors.lastname: Di Virgilio
authors.forename: D
authors.initials: D
authors.lastname: Parigino
authors.forename: P
authors.initials: P
authors.lastname: Tucci
authors.forename: M
authors.initials: M
authors.lastname: Bisceglia
authors.forename: M
authors.initials: M
authors.lastname: Rugge
authors.forename: A
authors.initials: A
authors.lastname: Tucci
authors.forename: A
authors.initials: A
authors.lastname: Andriulli
mesh_terms: D000328:Adult; D001706:Biopsy; D016145:Endoscopy, Digestive System / Q000379:methods; D005260:Female; D005744:Gastric Acid / Q000737:chemistry; D005750:Gastric Juice / Q000737:chemistry*; D005753:Gastric Mucosa / Q000473:pathology*; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity