幽门螺杆菌对于溃疡性结肠炎发生发展的临床意义

目的研究溃疡性结肠炎(ulcerative colitis,UC)患者感染幽门螺杆菌(Helicobacter pylori,H.pylori)的情况及两者关系.方法选取146例经肠镜及病理学检查确诊的UC患者为U C组;另选取150例经肠镜检查未见明显病变的健康体检者为对照组.回顾性分析两组经快速尿素酶试验和组织病理活检联合检测方法检测的H.pylori的感染情况.结果 UC组患者146例,27例阳性,H.pylori感染的阳性率为18.49%,对照组150例体检者,64例阳性,H.pylori感染的阳性率42.67%,UC组明显低于对照组,差异有统计学意义(P0.05).按病变范围:直肠组27例,7例阳性,H.pylori阳性率为21.88%,左半结肠组48例,9例阳性,H.pylori阳性率为18.75%,广泛结肠组66例,11例阳性,H.pylori阳性率为16.67%.三组间比较,差异无统计学意义(P0.05).活动期UC患者117例(80.14%),缓解期UC患者29例.缓解期H.pylori感染率阳性率最高(37.93%),重度活动期感染率最低(6.25%),差异较为明显(P0.05).结论 H.pylori感染可能对UC的发生发展起预防保护作用,随疾病严重程度增加,H.pylori阳性率降低.此外加强UC患者的随访依从性也将非常重要.     

中国汉族炎症性肠病幽门螺杆菌感染状况分析

目的: 调查中国汉族IBD患者H pylori感染情况和IBD治疗药物及克罗恩病(CD)表型与H pylori感染的可能关系.方法: 收集106例IBD患者, 其中包括54例溃疡性结肠炎(UC)和52例CD, 对照组包括106例年龄和性别及社会经济状况与之匹配且接受了常规的体格检查的健康人. 采用H pylori IgG抗体胶体金免疫层析快速诊断试验比较了IBD患者和健康对照者H pylori的感染率.结果: IBD患者和对照组以及UC和CD患者之间H pylori感染率, 均具有显著性差异(31.1% vs61.3%, P<0.01;37.0% vs 25.0%, P<0.05). 在IBD患者中, 曾服用甲硝唑(22.3%)或喹诺酮类抗菌药(19.1%)的患者比对照组H pylori感染率显著降低, 而没有服用抗生素的患者也表明H pylori感染率显著低于对照组. IBD患者的表型特征与H pylori感染率没有显著的关系( P>0.05).结论: 中国汉族IBD患者, 特别是CD患者的H pylori感染率显著的低于正常对照者, 认为H pylori感染在IBD患者中可能是一种低危险因素.     

唾液、牙斑与胃黏膜幽门螺杆菌感染关系的研究

背景幽门螺杆菌(H.pyloori)在人群中感染率高,但其传播途径仍不清楚.目前有关口腔中H.pylori感染与胃黏膜H.plori感染关系的研究不多.目的了解口腔中的H.pylori感染状况及其与胃黏膜H.pylori感染的关系.方法应用聚合酶链反应(PCR)技术同时检测60例非萎缩性胃炎患者唾液、牙斑和胃黏膜中的H.pylori.结果47例胃黏膜H.pylori阳性的胃炎患者中有31例(66.0%)唾液中检出H.pylori,17例(36.2%)牙斑中检出H.pylori;而13例胃黏膜H.pylori阴性的胃炎患者中仍有1例(7.7%)唾液中检出H.pylori,2例(15.4%)牙斑中检出H.pylori.胃黏膜H.pylori阳性与阴性胃炎患者唾液和牙斑中的H.pylori检出率有显著差异(P＜0.01).结论口腔中的H.pylori与胃黏膜中的H.pylori之间可能存在一定的病因学联系.     

胃食管反流病与幽门螺杆菌感染的关系研究

目的:探讨胃食管反流病(GERD)与幽门螺杆菌感染(H.pylori)的关系。方法:将内镜检查确诊的112例GERD患者,按H.pylori检测结果分为H.pylori( )组和H.pylori(-)组,以内镜下食管炎的分级进行严重度比较。H.pylori( )组H.pylori根除后与H.pylori(-)组在半年、1年后进行复发率的比较。结果:H.pylori( )组和H.pylori(-)组GERD重度检出率分别为36.8%(7/19)和63.2%(12/19),差异有显著性。H.pylori( )GERD患者H.pylori根除后半年、1年食管炎总复发率为70.5%与H.pylori(-)组GERD47.0%比较差异有显著性。结论:H.pylori(-)者GERD重,H.pylori( )GERD患者H.pylori根除后1年食管炎复发率较高,H.pylori对GERD可能有保护作用。     

慢性乙型肝炎患者幽门螺杆菌感染的调查分析

目的探讨慢性乙型肝炎患者幽门螺杆菌(H.pylori)的感染情况及其临床意义。方法将167例慢性乙型肝炎患者分为肝炎组、肝硬化组、肝癌组,研究H.pylori感染状况与76例健康对照者的关系,并进一步分析H.pylori感染与肝功能、临床并发症的关系。结果慢性乙型肝炎患者H.pylori感染率为64.1%,明显高于健康对照组34.2%(P<0.01)。其中肝硬化组71.8%和肝癌组75.0%又高于肝炎组51.5%(P<0.05)。H.pylori阳性患者肝性脑病、上消化道出血及ALT水平高于H.pylori阴性患者(P<0.05),H.pylori阳性和H.pylori阴性患者的腹水并发症及TBIL差异无统计学意义(P>0.05)。结论慢性乙型肝炎患者H.pylori感染率显著增加,且H.pylori感染可能加重肝病病程。     

幽门螺杆菌与结直肠腺瘤发病关系的Meta分析

目的探讨结直肠腺瘤与幽门螺杆菌(Helicobacter pylori,H. pylori)感染之间的关系。方法选择徐州医科大学附属医院住院同时完成H. pylori检测和结直肠镜检查的患者354例,分为腺瘤性息肉组(n=146)、增生性息肉组(n=100)、对照组(n=108),分析H. pylori感染与结直肠腺瘤之间的关系。并回顾收集到的关于H. pylori感染与结直肠腺瘤发病关系的研究进行Meta分析。结果腺瘤组与增生组,增生组与对照组之间H. pylori感染率差异无统计学意义(P 0. 05),腺瘤组与对照组组之间H. pylori感染率差异有统计学意义(P 0. 05)。Meta分析纳入31项研究,腺瘤组8 645例,对照组16 305例,腺瘤组H. pylori感染率明显高于对照组(P 0. 05)。结论 H. pylori感染会增加结直肠腺瘤的发病率。     

幽门螺杆菌与炎症性肠病的关系

炎症性肠病(inflammatory bowel disease,IBD)是肠道慢性炎症性疾病,主要分为克罗恩病(Crohn’s disease,CD)和溃疡性结肠炎(ulcerative colitis,UC);近年来IBD的发病率急剧增高,尤其是在发展中国家;虽然关于IBD的研究取得了很大进展,但其确切发病机制仍不明确,目前IBD尚不能治愈,只能缓解。研究显示免疫、感染、遗传等因素是其可能的致病因素。幽门螺杆菌(Helicobacter pylori,H.pylori)是人类常见的致病菌,是引起胃炎、消化性溃疡和胃癌等疾病明确病原菌;近年来,不断有证据表明H.pylori可以通过诱导免疫耐受、降低炎症反应等作用对IBD产生一定的保护作用。这一现象对研究IBD的发病机制及寻找特异性的治疗手段有重大意义,本文就H.pylori感染与IBD的关系及其机制作一概述。     

幽门螺杆菌感染与儿童支气管哮喘发病的相关性研究

目的探讨幽门螺杆菌(Helicobacter pylori,H.pylori)感染与儿童支气管哮喘发病的关系。方法采用14C呼气试验检测H.pylori感染,比较H.pylori感染儿童与正常儿童之间的哮喘发病率和病情发展情况。结果 H.pylori感染儿童哮喘发病率较正常儿童低(6.33%vs 12.66%,P0.05);H.pylori阳性的哮喘儿童较H.pylori阴性的哮喘儿童拥有更长的缓解期(P0.05)。结论H.pylori感染与儿童哮喘的发病和复发呈负相关,具体机制有待进一步研究。     

幽门螺杆菌感染与糖尿病

糖尿病患者幽门螺杆菌(Helicobacter pylori,H.pylori)感染率明显增加,H.pylori感染作为一个独立因素可促使胰岛素抵抗.糖尿病患者中的H.pylori根除率较正常人为低,合并H.pylori感染的糖尿病患者血糖波动范围增大,血糖不易被控制,治疗效果不佳,而根除H.pylori后有助于改善糖尿病的进展.H.pylori感染与糖尿病并发症(如糖尿病肾病、动脉粥样硬化、胃轻瘫等)的发生也有一定关系.H.pylori感染影响糖尿病的机制可能与系统性炎症反应、血管内皮损伤和激素水平改变(如瘦素和胃饥饿素)等因素有关.     

胃粘膜相关淋巴样组织淋巴瘤抗H.Pylori治疗的有效预测因子

胃粘膜相关淋巴样组织(MALT)型结外边缘区B细胞淋巴瘤发病机制主要与幽门螺杆菌(H.pylori)感染有关,目前认为根治H.pylori治疗已成为胃粘膜相关淋巴样组织淋巴瘤的一线治疗。然而,抗H.pylori治疗不能使胃MALT淋巴瘤100%完全缓解,即使完全缓解后仍有复发的可能。随着研究的深入,哪些患者更能从抗H.pylori治疗中受益,抗H.pylori治疗后随访是目前研究的热点。此文对胃MALT淋巴瘤与H.pylori的关系,抗H.pylori治疗的有效预测、随访作一综述。     

Helicobacter pylori infection: A clinical overview

BACKGROUND: Helicobcater pylori colonizes the stomach of more than half of the world's population, and the infection continues to play a key role in the pathogenesis of a number of gastroduodenal diseases. Colonization of the gastric mucosa with Helicobcater pylori results in the development of chronic gastritis in all infected individuals and in a subset of patients chronic gastritis progresses to complications (i.e. ulcer disease, gastric neoplasias, some distinct extragastric disorders). The clinical outcome of the disease is dependent on many variables, including Helicobcater pylori genotype, innate host physiology, genetic predisposition and environmental factors. Helicobcater pylori eradication decreases the incidence of gastroduodenal ulcer and prevents its recurrence. Helicobcater pylori eradication for gastric cancer prevention has been suggested by preclinical research and clinical trials, showing even reversibility of precancerous lesions (atrophic gastritis and intestinal metaplasia) after Helicobcater pylori eradication. AIMS: To review the current literature about H. pylori and its related pathologies. CONCLUSION: At present, several clinical manifestations are recognized to be causally linked to Helicobcater pylori infection, and most of them can be cured by Helicobcater pylori eradication. Besides the relationship of Helicobcater pylori and gastroduodenal diseases, it has been well established that Helicobcater pylori infection is also involved in some extragastrointestinal diseases.     

Crohn’s disease incidence evolution in North-western Greece is not associated with alteration of NOD2/CARD15 variants

AIM To assess the trends in the incidence of inflammatory bowel disease (IBD) over 23 years in the same area and to identify genetic factors related to incidence evolution.METHODS Patients with IBD arising from Northwestern Greece were systematically recorded through the 1983-2005 period. Trends in disease incidence and genetic patterns related to CARD15 variants were documented and correlated.RESULTS A total of 447 patients with IBD were recorded (23.5% Crohn's disease, 72.7% Ulcerative colitis and 3.8% indeterminate colitis). Mean annual incidence rates of CD and UC were 0.9/100000 (95% CI 0.1-1.7) and 2.7/100000 (95% CI 1.7-4.1) inhabitants,respectively. There was a statistically significant increase of CD incidence (P ＜ 0.01) during the study period, in contrast to the UC incidence. There were no statistical differences in CARD15 variants over the study period.CONCLUSION The incidence of CD in North-western Greece has risen disproportionately to that of UC in the 21st century. This is not related to alterations of genetic background though.     

螺杆菌感染与慢性肝病研究现状与进展

有关螺杆菌感染与肝病相关的研究逐渐增加,主要是研究螺杆菌对肝病的影响,而肝病对螺杆菌的作用研究甚少。介绍了肝病时螺杆菌的细菌学、流行率,螺杆菌引起肝病的发病机制和诊断。至目前为止现已得到共识与人类肝病相关的螺杆菌有3种,即H.pylori、H.heilmanni和H.cinaedi,其中主要是H.pylori的研究,对于后两者研究不多,而肝螺杆菌属于H.pylori的1个新型。研究显示今后应主要在发病机制和预防上做更深入的研究。     

Epidemiology and natural history of inflammatory bowel diseases

In the West, the incidence and prevalence of inflammatory bowel diseases has increased in the past 50 years, up to 8-14/100,000 and 120-200/100,000 persons, respectively, for ulcerative colitis (UC) and 6-15/100,000 and 50-200/100,000 persons, respectively, for Crohn's disease (CD). Studies of migrant populations and populations of developing countries demonstrated a recent, slow increase in the incidence of UC, whereas that of CD remained low, but CD incidence eventually increased to the level of UC. CD and UC are incurable; they begin in young adulthood and continue throughout life. The anatomic evolution of CD has been determined from studies of postoperative recurrence; CD begins with aphthous ulcers that develop into strictures or fistulas. Lesions usually arise in a single digestive segment; this site tends to be stable over time. Strictures and fistulas are more frequent in patients with ileal disease, whereas Crohn's colitis remains uncomplicated for many years. Among patients with CD, intestinal surgery is required for as many as 80% and a permanent stoma required in more than 10%. In patients with UC, the lesions usually remain superficial and extend proximally; colectomy is required for 10%-30% of patients. Prognosis is difficult to determine. The mortality of patients with UC is not greater than that of the population, but patients with CD have greater mortality than the population. It has been proposed that only aggressive therapeutic approaches, based on treatment of early recurrent lesions in asymptomatic individuals, have a significant impact on progression of these chronic diseases.     

The translation of Helicobacter pylori basic research to patient care

In 1984, Barry Marshall and Robin Warren proposed a role for bacterial infections in the pathogenesis of gastroduodenal disease, which triggered an avalanche of research intended to prove or disprove their theory. The result has been a series of advances that have enhanced our understanding of these diseases and completely modernized the clinical approach to their management. In just over 20 years, many aspects of the immunopathogenesis of these diseases have been dissected at the molecular level, with key pathogenic mechanisms being validated by the identification of genes that are associated with the development of gastric cancer. There has been particular emphasis on understanding the molecular structures associated with Helicobacter pylori and their role in modifying the host responses. Gastric immune and inflammatory responses have emerged as key elements in the pathogenesis of gastritis and epithelial cell damage. This review summarizes important findings emanating from basic research primarily related to the immunopathogenesis of H pylori that have advanced the practice of medicine or our understanding of gastroduodenal disease.     

Geographical variations of inflammatory bowel disease in France: a study based on national health insurance data

BACKGROUND AND AIM: A north-south gradient in inflammatory bowel disease (IBD) incidence has been found in Europe and the United States. Its existence is inferred from comparisons of registries that cover only small portions of territories. Several studies suggest that IBD incidence in the north has reached a plateau, whereas in the south it has risen sharply. This evolution tends to reduce the north-south gradient, and it is uncertain whether it still exists. In France, patients with IBD are fully reimbursed for their health expenses by the national health insurance system, which is a potential source of data concerning the incidence of IBD at the national level. The aim of this study was to assess the geographical distribution of Crohn's disease (CD) and ulcerative colitis (UC) in France and to test the north-south gradient hypothesis. METHODS: This study was conducted in metropolitan France and included patients to whom IBD reimbursement was newly attributed between January 1, 2000 and December 31, 2002. Data provided relate to age, sex, postcode area of residence, and IBD type. The mapping of geographical distribution of smoothed relative risks (RR) of CD and UC was carried out using a Bayesian approach, taking into account autocorrelation and population size in each département. RESULTS: In the overall population, incidence rates were 8.2 for CD and 7.2 for UC per 100,000 inhabitants. A clear north-south gradient was shown for CD. Départements with the highest smoothed RR were located in the northern third of France. By contrast, the geographical distribution of smoothed RR of UC was homogeneous. CONCLUSIONS: This study shows a north-south gradient in France for CD but not for UC.     

Helicobacter pylori: a debated factor in gastroesophageal reflux disease

The prevalence of Helicobacter pylori infection is steadily decreasing in developing countries, and this has been paralleled by an increasing incidence of gastroesophageal reflux disease (GERD) and adenocarcinomas of the esophagus and of the esophagogastric junction. The prevalence of H. pylori infection, which is on the decline in Europe and in the United States, is probably related to improvements in sanitary conditions and socioeconomic status. These epidemiological data do not support a role for H. pylori in the pathogenesis of GERD, but at the same time suggest a negative association with the rising incidence in esophageal diseases. While H. pylori infection clearly does not cause GERD, it may protect certain susceptible individuals from the development of GERD and its complications. There are conflicting reports that GERD can develop after H. pylori eradication and that proton pump inhibitors are less effective in suppressing intragastric acidity in H. pylori negative patients--reasons not to eradicate H. pylori in GERD patients. On the contrary, other data suggest an increase in the development of atrophic gastritis in GERD patients (H. pylori positive) on long-term proton pump inhibitor therapy - a reason to eradicate H. pylori. Preexisting lower esophageal sphincter dysfunction, susceptibility to GERD, unmasking of latent GERD, and patterns and severity of gastritis may be important factors contributing to the development of GERD rather than just the presence or absence of infection with H. pylori.     

Consensus guidelines: agreement and debate surrounding the optimal management of Helicobacter pylori infection.

Helicobacter pylori is a recognized cause of a variety of gastroduodenal pathology. The high prevalence of both H pylori infection and related diseases within the community warrants its consideration as a public health care issue. The availability of reliable and safe noninvasive diagnostic techniques coupled with the development of effective and tolerable treatments has enabled primary health care personnel to manage this infection actively. The role of the primary care physician in the future management of H pylori infection is thus of central importance. The wealth of evidence produced by over 15 years of research into H pylori has expanded the list of disease associations and treatment benefits as well as elucidated the pathophysiological mechanisms involved. As a result, there has been a growing need to harmonize this information with clinical practice and to provide direction for the appropriate management by both specialists and general practitioners. Several national guidelines have been produced. The areas relating to H pylori infection that they considered and their recommendations vary. In 1994, the National Institutes of Health produced globally accepted recommendations for the management of H pylori-related peptic ulceration. The broader role of H pylori as a gastroduodenal pathogen and a public health care issue was not addressed. Recently, European and Canadian consensus guidelines have been published that identified overall management issues, including the role of primary and specialist care, and considered the appropriateness of employing eradication therapy for the spectrum of conditions in which H pylori has a direct or indirect association based on the available information. These guidelines, while in agreement regarding many issues, differ considerably in their recommendations for primary health care and regarding central issues such as the management of dyspepsia and gastric cancer. Some variations may reflect differing health care structures as well as the prevalence of both infection and associated diseases. However, the interpretation of evidence produced by recent research contributes to their conflicting statements.     

Clinical efficacy and safety of modified Sijunzi decoction for the treatment of ulcerative colitis: A protocol for a systematic review and meta-analysis

Background:Ulcerative colitis (UC) is a chronic non-specific intestinal inflammatory disease with unknown etiology. In recent years, the global incidence has been increasing. Sijunzi decoction (SJZD) is a traditional Chinese medicine that has been used for treatment of other diseases in previous studies as it has no side effects and it has a pharmacological effect in gastrointestinal function, immune system, ulcers, and tissue repair.Methods:PubMed, Embase, Cochrane Library, GeenMedical, China National Knowledge Infrastructure, Chinese Sci-tech Journals full-text Database, Chinese Biomedical Database, and Chinese Science Citation Database were searched to screen the related literatures of “ulcerative colitis” and “Jiawei Sijunzi decoction”. The research data extracted from above studies was analyzed by Review Manager 5.3 and Stata14.2 software.Results:This systematic review and meta-analysis will evaluate the efficacy and safety of Jiawei SJZD in the treatment of UC and provide effective evidence for clinical use.Conclusion:In this study, the published evidence of modified SJZD in the treatment of UC was systematically summarized and evaluated, so that it can be better applied in clinic.INPLASY registration number:INPLASY2020100102     

Epidemiology and clinical characteristics of ulcerative colitis in Chinese population: experience from a single center in Hong Kong

Background and Aim: Rising incidence and prevalence of ulcerative colitis (UC) had been observed in Asian countries. We conducted a study in an Asian center, aiming to describe the epidemiology and clinical characteristics of UC in local Chinese population. Methods: This is a retrospective analysis of patients with diagnosis of UC in our hospital from June 1990 to December 2006. The diagnosis of UC has to satisfy the internationally accepted criteria. All patients were Chinese residents in a well‐defined catchment area. Clinical and epidemiological data were obtained from medical records and patient interviews. Results: Seventy‐three Chinese UC patients had been managed in our hospital. The hospital‐based prevalence had risen by three times over a 10‐year period, but no definite rising incidence can be demonstrated. The mean age at diagnosis was 40.6 years and the median duration of disease is 72 months. In our patient cohort, 38.4% had ulcerative proctitis and 26% had left‐sided UC, whereas 35.6% had extensive UC at presentation. The majority presented with mild (39.7%) or moderate (30.2%) disease activity, but 27.4% presented with severe disease. Two patients (2.7%) present with fulminant disease with one of them developed toxic megacolon. Extra‐gastrointestinal manifestations occurred in 13.7%. During the follow‐up period, most patients (86.3%) were in disease remission. Four patients (5.5%) underwent colectomy, four patients (5.5%) died, and two patients (2.7%) were lost to follow up. Conclusion: The prevalence but not the incidence of UC is rising in Chinese population. It usually affects young patients and a substantial proportion of patients presented with severe and fulminant disease. The disease activity of most Chinese patients can be controlled with medical treatment, though a small proportion of patients need surgery or have fatal outcome.