가정의학과 외래 위내시경 검사에 대한 고찰

Abstract

Background : Upper gastrointestinal (UGI) symptoms, which are shown by various aspects, are very frequently met on family practice fied, and the diagnostic method has been dependent mostly on endoscopic with or without biopsy. As the patients who needed eddoscopic diagnosis with biopsy owing to complaining various UGI symptoms, we urveyed mutual correlations in order to refer the data in practical field focusing on following items ; sex, age, symptom, duration, lesion site distribution, and sensitivity/specificity/pre-dictive value of endoscopic diagnosis according to confirmation with endoscopic biopsy

Methods : A clinical analysis was carried out on 673 patients taken the endoscopic biopsy who ahve UGI symptoms from April 1991 to July 1994 in department of family medicine, Keimyung University College of Medicine. The sex, age, symptom, duration, lesion site, endoscopic/pathologic diagnosis distribution and correlation of each variable were surveyed.

Results : 1. Of the toal 673 cases, the ratio of male to ffemale was 1.7:1 and the age distribution was in the order of the fifties, forties, thirties and sixties. The symptom distribution was in the order of hunger pain, epigastric soreness, dyspepsia, postprandial pain and fullness. The symptom duration of gastric cancer was 99.5 weeks which was significantly longer than those of gastritis 74.5 weeks and gastric ulcer 73.4 weeks. The most prevalent sex of gastritis, gastric ulcer, gastic cancer was all male, and male to female ratio was 1.7:1, 1.7:1, 2.1:1, respectively. 2. For gastric lesion according to pathologic diagnosis, the gastritis was found in 369 cases(54.8%), followed by gastric ulcer 239 cases(35.5%), and gastric cancer 65 cases (9.7%) For the site distribution of pathologic diagnosis, gastric ulcer, and gastric cancer were in the order of antrum, pylorus, angle, body, respectively all. 3. For the sensitivity and specificity of the gastritis, ulcer, and gastric cancer by endoscopic diagnosis according to pathologic diagnosis, it was repectively 77% and 88%, 86% and 78%, and 58% and 97%, and the positive predictive value was respectively 89%, 69%, and 69%, and the false positive value was respectively 12%, 22%, 3%.

Conclusion : The authors in family practice field conducted endoscopic diagnosis with biopsy on 673 patients and studied the sensitivity, and predictive value of endoscopic diagnosis according to the pathologic diagnosis by lesion site biopsy. For the patients complaining the UGI symptoms, since the endoscopic diagnosis with biopsy conduc-ting family practice field solve their problems and improve the compliance, it is necessary to make and extensive study and obtain profound experience on endoscopic diagnosis.