Abstract
BackgroundA clinical history of peptic ulcer has been reported to be associated with a high rate of ulcer recurrence in nonsteroidal anti-inflammatory drug (NSAID) users. Therefore, it is a very important issue to precisely know the previous history prior to NSAIDs administration. To clarify the possible difficulty to identify the history, we determined the sensitivity and diagnostic concordance of endoscopy for the identification of ulcer scars indicative of previous clinical history of peptic ulcer diseases.MethodsThe first study enrolled 200 consecutive patients with a clinical history of gastric or duodenal ulcers previously confirmed by esophagogastroduodenoscopy. The sensitivity of endoscopy for identifying scars was determined for these patients. In the second study, the extent of interobserver agreement was determined for 47 endoscopists who identified ulcer scars in endoscopic photographs of 30 sites of previous active gastric ulcers and 30 sites of previous active duodenal ulcers. The kappa coefficient of reliability was calculated to measure the interobserver agreement on the diagnosis of ulcer scars.ResultsOut of 190 patients eligible for analysis, 104 (54.7%) were found to have gastric or duodenal ulcer scars on endoscopy; there were no gastric or duodenal ulcer scars seen in the remaining patients (45%). In the second study, the kappa values for endoscopic diagnosis of gastric and duodenal ulcer scars were 0.14 (95% CI 0.13-0.16) and 0.29 (95% CI 0.27-0.32), respectively. The addition of indigo-carmine chromoendoscopy did not provide a statistically significant improvement in diagnostic concordance in patients with gastric ulcer scar since the kappa value for chromoendoscopic diagnosis was 0.15; 95% CI 0.13-0.17 as low as for un-contrasted scars.ConclusionsThe sensitivity and concordance of endoscopic diagnosis of gastric and duodenal ulcer scars are not satisfactory for the use of endoscopy only to identify previous ulcer disease. To avoid the overlooking the previous clinical history of peptic ulcer diseases, the diagnosis of peptic ulcer scar has to be carefully done prior to NSAIDs administration.
Highlights
A clinical history of peptic ulcer has been reported to be associated with a high rate of ulcer recurrence in nonsteroidal anti-inflammatory drug (NSAID) users
Interobserver agreement on endoscopic diagnosis A confident endoscopic diagnosis of ulcer scars was possible in 70% and 72% of patients with previous gastric and duodenal ulcers, respectively (Figure 2 and 3)
The kappa value of the endoscopic diagnosis on the presence or absence of a gastric ulcer scar was 0.14 in all the participating endoscopists (Figure 4)
Summary
A clinical history of peptic ulcer has been reported to be associated with a high rate of ulcer recurrence in nonsteroidal anti-inflammatory drug (NSAID) users. Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed and have become increasingly associated with adverse gastroduodenal events [1,2]. Gastric and duodenal ulcers have been reported to be found in as high as 17% of chronic NSAIDs users and 12% of agents [5,6,7,8,9,10,11]. NSAIDs or LDA users with a past history of gastric or duodenal ulcers should be carefully managed with appropriate coadministration of PPIs [14,15]. Whether or not endoscopic examination is sensitive enough to detect a previous gastric or duodenal ulcer has not been thoroughly investigated. The aims of this study were to determine the sensitivity of endoscopy used as a tool for detecting ulcer scars and to determine interobserver agreement in the endoscopic diagnosis of ulcer scars
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