Graham Johnson introduces the first non-invasive test for assessing the structure and function of the stomach in patients with dyspepsia. It can be used in the primary care setting and also in secondary care as a pre-endoscopy assessment tool.
Dyspepsia is a common health issue in the UK, affecting 20–40% of the population.1 It is generally well managed by GPs in primary care; however, in refractory cases or when patients present with more urgent symptoms, it may indicate something potentially more sinister. Dyspepsia can signal diseases in the gastrointestinal (GI) tract, including atrophic gastritis (AG) or gastric intestinal metaplasia (GIM), both of which are significant risk factors for gastric cancer.
Atrophic gastritis can be caused by a persistent Helicobacter pylori infection in the gastric mucosa or by autoimmune mechanisms, and 18% of cases progress to cancer within 10 years.2 H. pylori is a class 1 (carcinogenic) pathogen and dyspeptic patients can be tested for the bacterium in primary care under current patient care pathways. For some patients with new onset of dyspepsia or alarm symptoms, referral for endoscopy is common, which is invasive and a huge cost burden to the healthcare system.
Endoscopy can help to identify mucosal damage through careful enhanced imaging techniques and biopsy analysis, but tests for H. pylori used in isolation cannot, and so this poses a challenge to primary care clinicians in knowing which patients to refer. Identifying H. pylori and/or any mucosal damage at an earlier stage can help to stratify the cohort of patients who are at a higher risk of developing gastric cancer, and refer them to endoscopy sooner.
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