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An alternative workup expands the TT-strategy by incorporating esophagogastroduodenoscopy (Test-Treat-and-Scope [TT-S]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This prospective cross-sectional study provides evidence-based insights into the clinical workup of dyspepsia by applying the TT and TT-S options.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>\n                      In a consecutive cohort of 2171 dyspeptic patients without alarm symptoms,\n                      <jats:italic>H. pylori (Hp)<\/jats:italic>\n                      status was assessed by\n                      <jats:sup>13<\/jats:sup>\n                      C-Urea Breath Test, Rapid urease test, and histology. Histology profiling was based on six biopsies and included atrophy staging (OLGA-system).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among\n                      <jats:italic>Hp<\/jats:italic>\n                      -positive and\n                      <jats:italic>Hp<\/jats:italic>\n                      -negative patients, the prevalence of mucosal atrophy was 22.2% and 1.3% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), respectively. In the study population, 92.5% did not exhibit atrophic disease (OLGA stage 0). Among\n                      <jats:italic>Hp<\/jats:italic>\n                      -positive patients, mucosal atrophy occurred in 142\/640 subjects. Nine in 640 (1.4%)\n                      <jats:italic>Hp<\/jats:italic>\n                      -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\n                      <jats:italic>Hp<\/jats:italic>\n                      -positive). The mean age of patients with OLGA stages III-IV was 15 years older than that of non-atrophic patients (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). In all atrophic OLGA-stages,\n                      <jats:italic>Hp-<\/jats:italic>\n                      positive subjects dominated over the\n                      <jats:italic>Hp<\/jats:italic>\n                      -negative (test-for-trend;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). None of the\n                      <jats:italic>Hp<\/jats:italic>\n                      -negative subjects showed extensive atrophy (OLGA-stages III-IV).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      In the considered epidemiological context, advanced gastric atrophy (OLGA-stages III-IV), consistently recognized as at risk of cancer development, only occurred in\n                      <jats:italic>Hp-<\/jats:italic>\n                      positive patients over 55 years. These results support the priority of the TT-S-strategy in\n                      <jats:italic>Hp<\/jats:italic>\n                      -positive patients older than 55, even in the absence of alarm symptoms.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10120-026-01732-z","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T08:44:17Z","timestamp":1775033057000},"page":"540-549","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Gastric cancer secondary prevention in dyspeptic patients"],"prefix":"10.1007","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0381-8302","authenticated-orcid":false,"given":"Giulia","family":"Fiorini","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0679-0563","authenticated-orcid":false,"given":"Massimo","family":"Rugge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3765-9111","authenticated-orcid":false,"given":"Nimish","family":"Vakil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2747-3732","authenticated-orcid":false,"given":"Antonietta","family":"D\u2019Errico","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6475-3026","authenticated-orcid":false,"given":"Matteo","family":"Pavoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4908-5506","authenticated-orcid":false,"given":"Stefano","family":"Guzzinati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2329-8105","authenticated-orcid":false,"given":"Angelo","family":"Zullo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5789-3813","authenticated-orcid":false,"given":"Luigi","family":"Gatta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriella","family":"Massarenti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Rosa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Marchesani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2309-7365","authenticated-orcid":false,"given":"Giulia","family":"Collatuzzo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2234-8262","authenticated-orcid":false,"given":"Cinzia","family":"Papadia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9745-0726","authenticated-orcid":false,"given":"Giovanni","family":"Barbara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8039-8781","authenticated-orcid":false,"given":"Claudio","family":"Borghi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9086-3675","authenticated-orcid":false,"given":"Dino","family":"Vaira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"issue":"10","key":"1732_CR1","doi-asserted-by":"publisher","first-page":"1510","DOI":"10.1111\/nmo.12639","volume":"27","author":"SJ Lee","year":"2015","unstructured":"Lee SJ, Park H, Choi KD, et al. 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