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Background <p>In dyspeptic patients without alarm symptoms, the “Test-and-Treat” (TT) strategy aims to alleviate symptoms and prevent adverse outcomes. An alternative workup expands the TT-strategy by incorporating esophagogastroduodenoscopy (Test-Treat-and-Scope [TT-S]).</p> Objective <p>This prospective cross-sectional study provides evidence-based insights into the clinical workup of dyspepsia by applying the TT and TT-S options.</p> Design <p>In a consecutive cohort of 2171 dyspeptic patients without alarm symptoms, <i>H. pylori (Hp)</i> status was assessed by <sup>13</sup>C-Urea Breath Test, Rapid urease test, and histology. Histology profiling was based on six biopsies and included atrophy staging (OLGA-system).</p> Results <p>Among <i>Hp</i>-positive and <i>Hp</i>-negative patients, the prevalence of mucosal atrophy was 22.2% and 1.3% (<i>p</i> &lt; 0.001), respectively. In the study population, 92.5% did not exhibit atrophic disease (OLGA stage 0). Among <i>Hp</i>-positive patients, mucosal atrophy occurred in 142/640 subjects. Nine in 640 (1.4%) <i>Hp</i>-positive patients presented advanced atrophy (OLGA-stages III-IV), considered at high-risk for gastric cancer. The overall prevalence of high-risk OLGA stages (III-IV) was below 1.5% (all <i>Hp</i>-positive). The mean age of patients with OLGA stages III-IV was 15 years older than that of non-atrophic patients (<i>p</i> &lt; 0.0001). In all atrophic OLGA-stages, <i>Hp-</i>positive subjects dominated over the <i>Hp</i>-negative (test-for-trend; <i>p</i> &lt; 0.0001). None of the <i>Hp</i>-negative subjects showed extensive atrophy (OLGA-stages III-IV).</p> Conclusion <p>In the considered epidemiological context, advanced gastric atrophy (OLGA-stages III-IV), consistently recognized as at risk of cancer development, only occurred in <i>Hp-</i>positive patients over 55 years. These results support the priority of the TT-S-strategy in <i>Hp</i>-positive patients older than 55, even in the absence of alarm symptoms.</p>

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Gastric cancer secondary prevention in dyspeptic patients

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月1日

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  • Giulia Fiorini,
  • Massimo Rugge,
  • Nimish Vakil,
  • Antonietta D’Errico,
  • Matteo Pavoni,
  • Stefano Guzzinati,
  • Angelo Zullo,
  • Luigi Gatta,
  • Gabriella Massarenti,
  • Beatrice Rosa,
  • Cristina Marchesani,
  • Giulia Collatuzzo,
  • Cinzia Papadia,
  • Giovanni Barbara,
  • Claudio Borghi,
  • Dino Vaira

摘要

Background

In dyspeptic patients without alarm symptoms, the “Test-and-Treat” (TT) strategy aims to alleviate symptoms and prevent adverse outcomes. An alternative workup expands the TT-strategy by incorporating esophagogastroduodenoscopy (Test-Treat-and-Scope [TT-S]).

Objective

This prospective cross-sectional study provides evidence-based insights into the clinical workup of dyspepsia by applying the TT and TT-S options.

Design

In a consecutive cohort of 2171 dyspeptic patients without alarm symptoms, H. pylori (Hp) status was assessed by 13C-Urea Breath Test, Rapid urease test, and histology. Histology profiling was based on six biopsies and included atrophy staging (OLGA-system).

Results

Among Hp-positive and Hp-negative patients, the prevalence of mucosal atrophy was 22.2% and 1.3% (p < 0.001), respectively. In the study population, 92.5% did not exhibit atrophic disease (OLGA stage 0). Among Hp-positive patients, mucosal atrophy occurred in 142/640 subjects. Nine in 640 (1.4%) Hp-positive patients presented advanced atrophy (OLGA-stages III-IV), considered at high-risk for gastric cancer. The overall prevalence of high-risk OLGA stages (III-IV) was below 1.5% (all Hp-positive). The mean age of patients with OLGA stages III-IV was 15 years older than that of non-atrophic patients (p < 0.0001). In all atrophic OLGA-stages, Hp-positive subjects dominated over the Hp-negative (test-for-trend; p < 0.0001). None of the Hp-negative subjects showed extensive atrophy (OLGA-stages III-IV).

Conclusion

In the considered epidemiological context, advanced gastric atrophy (OLGA-stages III-IV), consistently recognized as at risk of cancer development, only occurred in Hp-positive patients over 55 years. These results support the priority of the TT-S-strategy in Hp-positive patients older than 55, even in the absence of alarm symptoms.