ABSTRACT
The aim of this study was to evaluate the influence of using Citric Acid on false negative rates induced by PPIs during (14)C-UBT in dyspeptic patients with H. pylori infection. In a crossover randomized controlled clinical trial, one hundred dyspeptic patients (46 females and 54 males) with determined H. pylori infection who referred to gastrointestinal Outpatient Clinic of Razi Hospital-Rasht, Iran. All the patients underwent a (14)C-UBT HELIPROBE(®) baseline test and the positive ones entered the second phase. They were divided randomly to two groups and started PPIs treatment by Pantoprazole (20 mg/daily Pantozol(®) Nycomed Company) and underwent two other UBTs in days 12-13 and 14-15 with and without 4 grams Citric Acid. In group I who underwent UBT with Citric Acid in days 12-13 (UBT2) and UBT without Citric Acid in days 14-15 (UBT3), there was no significant difference between the UBT results with and without Citric Acid (P≥0.05). In group II who underwent UBT without Citric Acid in days 12-13 and UBT with Citric Acid in days 14-15, the false negative rates were not significantly different between UBT with and without Citric Acid (P≥0.05). In both groups the results of UBT without Citric Acid after Pantoprazole consumption didn't change significantly compared to the baseline UBT. Also the difference between the false negative rates of baseline UBT and UBT without citric acid was not significant (P>0.05). These results suggest that acidification of gastric environment during (14)C-UBT cannot prevent false negative results and do not increase the accuracy of the test in patients taking PPIs.
ABSTRACT
BACKGROUND AND OBJECTIVES: Gastric cancer is a leading cause of cancer-related deaths in both sexes in Iran. This study was designed to assess upper GI endoscopic findings among people>50 years targeted in a mass screening program in a hot-point region. METHODS: Based on the pilot results in Guilan Cancer Registry study(GCRS), one of the high point regions for GC - Lashtenesha - was selected. The target population was called mainly using two methods: in rural regions, by house-house direct referral and in urban areas using public media. Upper GI endoscopy was performed by trained endoscopists. All participants underwent biopsies for rapid urea test (RUT) from the antrum and also further biopsies from five defined points of stomach for detection of precancerous lesions. In cases of visible gross lesions, more diagnostic biopsies were taken and submitted for histopathologic evaluation. RESULTS: Of 1,394 initial participants, finally 1,382 persons (702 women, 680 men) with a mean age of 61.7 ± 9.0 years (range:50-87 years) underwent upper GI endoscopy. H.pylori infection based on the RUT was positive in 66.6%. Gastric adenocarcinoma and squamous cell carcinoma of esophagus were detected in seven (0.5%) and one(0.07%) persons, respectively. A remarkable proportion of studied participants were found to have esophageal hiatal hernia(38.4%). Asymptomatic gastric masses found in 1.1% (15) of cases which were mostly located in antrum (33.3%), cardia (20.0%) and prepyloric area (20.0%). Gastric and duodenal ulcers were found in 5.9% (82) and 6.9% (96) of the screened population. CONCLUSION: Upper endoscopy screening is an effective technique for early detection of GC especially in high risk populations. Further studies are required to evaluate cost effectiveness, cost benefit and mortality and morbidity of this method among high and moderate risk population before recommending this method for GC surveillance program at the national level.
