Gastric juice analysis in clinical practice: why, how, and when. The experience with EndoFaster

Abstract

Gastric juice analysis may be useful for clinical purposes, including the detection of H. pylori infection and diffuse atrophic gastritis on gastric mucosa. EndoFaster is a novel device which performs real-time analysis of gastric juice revealing the infection and hypochlorhydria by measuring ammonium concentrations and pH levels. This review aimed to evaluate the clinical applications of such a tool. By considering data from overall 11 studies, the values of sensitivity, specificity, positive predictive value, negative predictive value, accuracy, positive likelihood ratio, and negative likelihood ratio were 90%, 86%, 67%, 96%, 87%, 8.5, and 0.13, respectively, for H. pylori diagnosis, and 83%, 92%, 58%, 97%, 91%, 9.9 and 0.2, respectively, for suspecting diffuse atrophic gastritis. The very high value of negative predictive values for both H. pylori and mucosal atrophy would allow avoiding to perform useless negative gastric biopsies when the results of the test are negative. Some promising data suggest that gastric juice analysis may be useful also to diagnose H. pylori infection in patients with chronic active gastritis without evidence of bacteria at histology, as well as in predicting persistent acid reflux in patients on proton pump inhibitor therapy for reflux disease.

Non-Coding RNA as Biomarkers and Their Role in the Pathogenesis of Gastric Cancer—A Narrative Review

“…Gastric juice analysis is a more invasive procedure than blood sampling as it requires inserting a nasogastric tube to aspirate the fluid. However, this method may be useful in diagnosing H. pylori infection or lesions of the gastric mucosa that are not macroscopically detectable [208]. Ummarino et al [209] evaluated whether gastric juice analysis could minimise the number of performed biopsies or identify patients in whom biopsies should be performed.…”

Autoimmune Gastritis and Hypochlorhydria: Known Concepts from a New Perspective

“…The traditional basal and pentagastrin-stimulated acid secretion investigation is complex and invasive and has become obsolete in clinical practice. A real-time device for analysis of gastric acidity has been developed to analyze the pH of gastric juice aspirated during upper gastrointestinal endoscopy, and ammonium concentration to assess for Hp infection, and communicate the result during examination [64]. It needs 3 mL of gastric juice, and it measures the pH value in 15 s and ammonium concentration for the detection of Hp infection generally in 60 s [65].…”

“…From a 2023 review by Zullo et al that considered data from 11 studies [64], it emerged that standard biopsy sampling in the stomach could be eventually avoided in several patients with normally appearing gastric mucosa but without Hp infection or gastric atrophy in this real-time analysis (risk of false negative: 3-4 patients every 100). The values of sensitivity, specificity, positive predictive value, negative predictive value, accuracy, positive likelihood ratio and negative likelihood ratio for suspecting diffuse atrophic gastritis were 83%, 92%, 58%, 97%,91%, 9.9 and 0.2. respectively.…”

“…The values of sensitivity, specificity, positive predictive value, negative predictive value, accuracy, positive likelihood ratio and negative likelihood ratio for suspecting diffuse atrophic gastritis were 83%, 92%, 58%, 97%,91%, 9.9 and 0.2. respectively. This device, by analyzing the gastric juice, can help to improve the quality of gastroscopy, reducing biopsies if useless and also alerting the endoscopist to obtain the standard antral and gastric body mucosa specimens in those patients with positivity for at least one finding [64].…”