幽门螺旋杆菌感染与反流性食管炎的相关性研究

目的探讨幽门螺旋杆菌(HP)与反流性食管炎(RE)的相关性。方法回顾自2005至2009年间在攀枝花市西区大宝鼎社区卫生服务中心诊室接受胃镜检查的病例,选择被胃镜和病理诊断为RE与单纯慢性胃炎患者间的HP感染,分为无病变组(N)、十二指肠球部溃疡活动期组及瘢痕期组,同时各分为HP阳性、HP阴性共6组,进行反流性食管炎(RE)发病率对比性研究。结果 HP阴性的球部溃疡活动期组及瘢痕期两组的反流性食管炎发病率显著高于其他4组(P<0.05)。结论反流性食管炎(RE)可能对幽门螺旋杆菌(HP)的生存有抑制作用,RE多发生于HP阴性患者,HP呈阳性的患者,RE的炎症程度较轻。     

枸橼酸莫沙必利联合克拉霉素、法莫替丁治疗反流性食道炎并慢性咳嗽49例

目的探讨枸橼酸莫沙必利联合克拉霉素、法莫替丁治疗反流性食道炎并慢性咳嗽的临床疗效。方法选取2009年5月至2010年5月医院收治的反流性食道炎并慢性咳嗽患者98例,按入院先后顺序分为观察组和对照组,每组49例。对照组给予克拉霉素、法莫替丁,观察组在此基础上加用枸橼酸莫沙必利,观察两组反流性食道炎愈合、慢性咳嗽症状改善及不良反应情况。结果观察组反流性食道炎总有效率为93.88%(46/49),对照组为79.59%(39/49),差异有统计学意义(P<0.05);观察组慢性咳嗽总有效率为89.80%(44/49),对照组为73.47%(36/49),差异有统计学意义(P<0.05);观察组不良反应发生率为6.12%(3/49),对照组为4.08%(2/49),差异无统计学意义(P>0.05)。结论枸橼酸莫沙必利联合克拉霉素、法莫替丁治疗反流性食道炎并慢性咳嗽,能发挥多靶点协同作用的优势,迅速改善慢性咳嗽,促进反流性食道炎愈合,不良反应少,值得临床推广应用。     

中医辨证治疗反流性食道炎100例临床疗效观察

目的:观察中医辨证治疗反流性食道炎的临床疗效。方法:选取我院2010年2月～2012年2月间收治的反流性食道炎患者100例。本病属中医吐酸症,此症虽有寒热之分,但本病以脾胃虚弱为本,痰浊郁滞为标,故治疗重在健脾降浊。因此,采取中医健脾降浊方药治疗,观察和分析治疗前后的临床疗效。结果:治疗后,显效74例,有效21,无效5例。所有患者在改善烧心、嗳气泛酸、胸骨疼痛、恶心呕吐、胃脘胀痛等临床症状方面较治疗前比较,临床症状改善明显,较治疗前差异有统计学意义(P<0.01)。结论:中医辨证治疗反流性食道炎临床疗效显著,值得临床推广。     

胆汁反流性胃炎的临床分析

目的提高对反流性胃炎的认识,探讨其发病情况。方法回顾性分析2009年2月至12月在汕头潮南民生医院就诊的136例患者的临床表现、胃镜与病理特点、幽门螺旋杆菌(HP)检测和治疗情况。结果病变部位以胃窦、胃体为主,胃黏膜上可见胆汁淤块,黏膜充血,变脆或糜烂、出血、斑点。HP检查阳性64例(47.1%),全部病例均给予胃肠动力剂多潘立酮或莫沙比利、胆酸络合剂铝碳酸镁、黏膜保护剂瑞巴派特,本组有效率91.9%。结论胆汁反流性胃炎发生的机制与胃窦与十二指肠逆蠕动增多、幽门呈开放或半开放状态、胃窦收缩减弱等因素有关。HP也是胆汁反流性胃炎的病因之一,治疗选用胃肠动力剂多潘立酮或莫沙比利、胆酸络合剂铝碳酸镁、黏膜保护剂瑞巴派特能收到较好疗效。     

雷贝拉唑与奥美拉唑对老年性反流性食管炎临床疗效的比较

目的：比较雷贝拉唑和奥美拉唑治疗老年性反流性食道炎的临床疗效。方法：将院内 2008 年 3 月—2013 年 3 月期间收治的 144 例老年性反流性食道炎患者（包括住院患者和门诊患者），随机均分为对照组和观察组；对照组采用奥美拉唑治疗，而观察组治疗药物为雷贝拉唑；最后对两组患者的临床症状（主要有反流症状、食道刺激症状）以及内镜改善情况分别进行观察对比。结果：观察组的反流症状的有效率和食道刺激症状的缓解率分别为 81.9% 和 87.5%，均高于对照组（59.7%，59.7%）；而对照组的胃镜检查情况比观察组略差。结论：使用奥美拉唑治疗反流性食道炎的临床疗效相对较差，而雷贝拉唑的治疗效果优于前者，且能有效缓解老年人的疾病痛苦，改善生活质量，建议临床上推广应用。     

老年反流性食管炎的临床特征及内镜分析

目的探讨老年患者反流性食管炎的临床特征、内镜及HP感染等特点。方法收集2007～2012年在我院住院明确诊断的反流性食管炎患者为研究对象,选取同期诊断明确的年龄小于60岁的反流性食管炎作为对照组,分析其初诊的临床特征、内镜及HP感染等特点。结果就诊时的主要临床症状:老年反流性食管炎组主要临床表现为慢性咳嗽62.24%(61/98)、胸痛56.12%(55/98)、54.08%(53/98),非老年反流性食管炎组主要临床表现为反酸84.07%(132/157)、80.89%(127/157)、35.67%(56/157),老年反流性食管炎组反酸、烧心的发生率明显低于非老年组(P<0.05);老年反流性食管炎组不典型症状上腹不适、慢性咳嗽、支气管炎、胸痛高于非老年组(P>0.05)。两组病变程度比较:老年反流性食管炎组轻度、中度、重度分别占58.16%、31.64%、10.20%,非老年反流性食管炎组轻度、中度、重度分别占79.62%、13.38%、7.01%,中度反流性食管炎老年组明显高于非高龄老年组、而轻度反流性食管炎老年组明显低于非老年组,差异均由统计学意义(P<0.05)。两组幽门螺杆菌检出率比较:老年反流性食管炎组为31.64%,非老年反流性食管炎组35.67%,两组比较无统计学差异(P>0.05)。结论老年反流性食管炎患者程度重,典型症状发生率低,非典型症状发生率高,而反流性食管炎与幽门螺杆菌感染无关。     

多潘立酮治疗反流性食道炎和功能性消化不良的不良反应分析

目的分析多潘立酮治疗反流性食道炎和功能性消化不良的不良反应。方法回顾性分析2012年7月至2015年7月我院收治的反流性食道炎和功能性消化不良患者150例的临床资料,将其按照数字法分为参照组和治疗组,每组中有75例患者。参照组采用常规方案治疗,治疗组采用多潘立酮治疗,对两组不良反应发生率进行比较。结果参照组不良反应发生率为30.67%,治疗组不良反应发生率为16.00%,两组不良反应发生率进行比较,差异具有显著性(P<0.05)。结论多潘立酮治疗反流性食道炎和功能性消化不良的不良反应发生率低,安全可靠,具有积极的临床使用和推广价值。     

熊去氧胆酸治疗胆汁反流性胃炎胃电图变化

胆汁反流性胃炎亦称碱性反流性胃炎,是指由幽门括约肌功能失调或行降低幽门功能的手术等原因造成含有胆汁、胰液等十二指肠内容物反流入胃,在胃酸作用下,破坏胃黏膜屏障,引起H+弥散增加,而导致的胃黏膜慢性炎症。目前常规药物治疗包括促胃动力药物(如甲氧氯普胺、多潘立酮、莫沙必利),结合胆盐类药物(如达喜)、抑制胃酸分泌药物及抗幽门螺杆菌治疗。我院应用熊去氧胆酸治疗胆汁反流性胃炎疗效满意,并对胆汁反流性胃炎患者的胃电图变化进行了研究。     

老年人反流性食管炎的中医辨证治疗

反流性食管炎是因胃食管反流致反流物进入食管引起的食管粘膜炎症。老年人由于抗反流功能降低，并且食管粘膜上皮的增生、修复能力减弱，屏障功能下降，因此反流性食管炎在老年人群中发病率较高。自2000年以来，我们辨证治疗老年人反流性食管炎118例。     

不同地区胆汁反流性胃炎发病率的比较及临床诊治

目的探讨西藏自治区拉萨地区以及北京市和平里地区不同地域间胆汁反流性胃炎(BRG)发病率的差异,分析其病因及相关因素,制定相应的治疗对策。方法选择两地同一季节(2004年2月至2004年8月)以消化道症状就诊并行胃镜检查患者,依照统一的胃镜下诊断标准(排除外科手术后以及消化道肿瘤所致幽门解剖结构异常)对胆汁反流性胃炎发病率进行比较。结果拉萨地区BRG的发病率37%明显高于北京市和平里地区BRG的发病率23.9%,差异有显著意义。结论不同地区BRG发病率有显著不同,究其原因考虑与不同生活、饮食习惯,幽门螺杆菌感染情况,药物治疗的选择有关。     

Recurrent symptoms and gastro-oesophageal reflux disease in patients with duodenal ulcer treated for Helicobacter pylori infection

BACKGROUND: Eradication of Helicobacter pylori has been shown to prevent relapse of endoscopically detected duodenal ulcers. There is controversy regarding symptom improvement after therapy. Some studies have suggested that a substantial number of patients remain symptomatic after eradication therapy. Other studies suggest that gastro-oesophageal reflux disease (GERD) may develop as a result of H. pylori eradication. AIM: To determine the relationship between symptoms and H. pylori eradication and to determine whether H. pylori eradication results in symptoms or endoscopic findings of GERD. METHODS: Two hundred and forty-two patients with endoscopically documented duodenal ulcer disease and evidence of H. pylori infection by rapid urease testing and histology were studied in four randomized, placebo-controlled, double-blind trials of H. pylori eradication therapy. All patients underwent symptom assessment and endoscopy with biopsy before therapy and 1 and 6 months after completing therapy. The rapid urease test and histology were used to determine H. pylori status. Interviewers were blinded to H. pylori status after eradication and were unaware of the endoscopic findings (interviews were performed prior to repeat endoscopy). RESULTS: The presence of epigastric pain was significantly associated with persistent H. pylori infection 1 month after therapy (odds ratio 2.3, 95% CI: 1.02-5.2; P=0.041), as was nausea (OR 7.1, 95% CI: 0.93-55.6; P=0.029). The presence of epigastric pain was significantly associated with ulcer relapse at 6 months (OR 7.5, 95% CI: 3.6-15.7; P < 0.001) as was nausea (OR 5.1, 95% CI: 1.7-16.0; P=0.002). Heartburn was not associated with eradication of H. pylori or ulcer relapse. New onset reflux symptoms were reported by 17% (17 of 101 patients) at 6 months and were not significantly different in patients with (15%) and without (22%) persistent H. pylori infection (P=0.47). Erosive oesophagitis was present at endoscopy in one of the 17 cases that developed new heartburn. CONCLUSIONS: One month after completion of therapy, the presence of epigastric pain or nausea is associated with persistent infection and these symptoms at 6 months are suggestive of duodenal ulcer relapse. The incidence of GERD is not increased in patients who have eradication of H. pylori.     

Effect of Helicobacter pylori eradication on oesophageal acid exposure in patients with reflux oesophagitis

BACKGROUND: The effect of Helicobacter pylori eradication on reflux oesophagitis is unclear. AIM: To study the effect of H. pylori eradication on oesophageal acid exposure and disease severity in patients with reflux oesophagitis. METHODS: Patients with reflux oesophagitis and H. pylori infection were recruited for 24-h oesophageal pH-metry. They were then randomly assigned to receive either treatment for H. pylori eradication (1-week omeprazole-based triple therapy, followed by 7-week omeprazole) or omeprazole alone (8-week omeprazole). Uninfected patients were recruited as controls. Endoscopy, pH monitoring and symptom assessment were repeated at 26 weeks. RESULTS: Forty patients (25 H. pylori-positive and 15 uninfected) with erosive oesophagitis were studied. Fourteen were randomized to receive treatment for H. pylori eradication and 11 to receive omeprazole alone. There was no difference in the percentage of time the oesophageal pH < 4 before and 26 weeks after treatment among the three groups. However, the percentage of time the oesophageal pH < 2 (P=0.01) and pH < 3 (P=0.02) was significantly increased in patients receiving treatment for H. pylori eradication. Three (21%) patients in the group receiving treatment for H. pylori eradication had worsening of reflux oesophagitis. CONCLUSIONS: H. pylori eradication increases oesophageal acid exposure and may adversely affect the clinical course of reflux disease in a subset of patients.     

幽门螺杆菌感染与胃食管反流的关系

目的探讨胃食管反流病(GRED)与幽门螺杆菌(Hp)的关系。方法确诊的胃食管反流病患者60例及浅表糜烂性胃炎患者63例(对照组),均行幽门螺杆菌检测,再将60例GERD患者分为2组,25例常规三联抗HP治疗,为HP根除组,另外35例作为Hp持续感染组。随访1年。结果 60例GERD患者Hp感染率为58.3%,对照组Hp感染率82.5%,GERD患者Hp感染率低于对照组,差异有统计学意义(P0.05)。Hp根除组GERD复发率高于Hp持续感染组,差异有统计学意义(P0.05)。对照组Hp根除后GERD的发病率为25.5%。结论 Hp感染可能在GERD的发病过程中起保护作用。     

Effect of Helicobacter pylori infection and its eradication on nutrition

AIMS: To investigate the effects of Helicobacter pylori infection and eradication on nutrition. METHODS: The body weight, height, blood pressure, gastric juice pH and fasting serum levels of glucose, total protein, albumin, total cholesterol and triglyceride were measured in H. pylori-positive and H. pylori-negative subjects, and the effect of eradication of H. pylori on these parameters was determined. The development of gastro-oesophageal reflux disease after treatment was also examined. Eight patients underwent a pancreatic function test before and after H. pylori eradication therapy. RESULTS: The incidence of hypoproteinaemia in H. pylori-positive subjects was significantly higher than that in H. pylori-negative subjects. After eradication of H. pylori, the gastric juice pH values were significantly decreased, and the body weight and serum levels of total cholesterol, total protein and albumin were significantly increased. The incidence of hyperlipidaemia significantly increased and that of hypoproteinaemia significantly decreased in the group with eradication. Pancreatic function improved significantly after eradication of H. pylori. No significant changes in these parameters were observed in the group without eradication. Obese patients had a higher risk of the development of gastro-oesophageal reflux disease after eradication of H. pylori infection. CONCLUSIONS: The eradication of H. pylori appears to improve some nutritional parameters.     

The effect of Helicobacter pylori eradication on gastro-oesophageal reflux

BACKGROUND: Increased prevalence of oesophagitis has been reported following eradication of Helicobacter pylori. We hypothesized that H. pylori eradication might increase gastro-oesophageal acid reflux in patients with reflux oesophagitis. METHODS: Twenty-five consecutive patients (13 male, 12 female) with H. pylori infection and reflux oesophagitis grade I (22 patients) or II (three patients) were enrolled; mean age 49.9 (range 33-75) years. Twenty-four hour intra-oesophageal pH recording was performed before and 12 weeks after eradication of H. pylori, which was achieved using bismuth subnitrate suspension 150 mg q.d.s., oxytetracycline 500 mg q.d.s. and metronidazole 400 mg t.d.s. for 10 days. Eradication was confirmed by 14C-urea breath test 12 weeks after completion of treatment. The patients did not receive acid-suppressive medication. RESULTS: All patients had abnormal gastro-oesophageal reflux before anti-H. pylori treatment. After treatment, there was no significant change in the percentage of total time oesophageal pH < 4 (P=0.46) in the 23 patients in whom the infection had been cured. Nine of the cured patients had increased acid exposure, whereas 14 had decreased acid exposure. No significant change in reflux symptom scores was found. There was no relationship between change in acid exposure and symptom improvement. CONCLUSIONS: Twelve weeks after H. pylori eradication there was no consistent change in gastro-oesophageal acid reflux in patients with mild or moderate reflux oesophagitis.     

Impact of Helicobacter pylori eradication on heartburn in patients with gastric or duodenal ulcer disease -- results from a randomized trial programme

BACKGROUND: Helicobacter pylori infection has been proposed as a protective factor against the development of gastro-oesophageal reflux disease. AIM: To study heartburn and endoscopic findings before and after H. pylori eradication therapy in patients with peptic ulcer disease. METHODS: In a multicentre trial programme, patients (n = 1497) were randomized to the omeprazole triple therapy group or to the control group, and were followed for 1-6 months after treatment. Patients in whom the infection was eradicated were compared with those in whom infection persisted. The severity of heartburn was measured at baseline and at each return visit. Endoscopy was performed 6 months after therapy in two of the five studies. RESULTS: In patients with duodenal ulcer, there was a significantly lower prevalence of heartburn after successful eradication of H. pylori relative to that after failed eradication (estimated odds ratio, 0.48). The reduction in the prevalence of heartburn in patients with gastric ulcer was independent of the post-treatment H. pylori status. In studies in which ulcer relapse was included in the model, this factor emerged as a significant factor for heartburn. The observed incidence of oesophagitis at the last visit was not influenced by H. pylori status. CONCLUSIONS: Eradication of H. pylori in patients with peptic ulcer disease was associated with a reduced prevalence of heartburn. Prevention of ulcer relapse could be the true cause of this reduction.     

Systematic review: the effect of Helicobacter pylori and its eradication on gastro-oesophageal reflux disease in patients with duodenal ulcers or reflux oesophagitis

BACKGROUND: The effect of Helicobacter pylori in provoking or protecting against gastro-oesophageal reflux disease is unclear and studies have given conflicting results. Recent guidelines recommend H. pylori eradication in patients on long-term proton pump inhibitors. AIM: To ascertain the effect of H. pylori eradication on gastro-oesophageal reflux disease outcomes (reflux oesophagitis and heartburn) in patients with duodenal ulcer disease, and to ascertain the effect of H. pylori infection on reflux oesophagitis concerning heartburn, pH, severity, healing and relapse rates. METHODS: A systematic review of electronic databases was undertaken to September 2003. Experts in the field, pharmaceutical companies and journals were contacted about unpublished trials. Studies were reviewed according to predefined eligibility and quality criteria. Twenty-seven studies/trials were included in the systematic review. RESULTS: Study variation rather than therapy-influenced results in relation to the presence or absence of oesophagitis in patients with duodenal ulcer who underwent H. pylori eradication at 6-48 months follow-up. In patients with reflux oesophagitis no obvious differences were discovered in heartburn scores, 24-h pH values, healing and relapse rates between H. pylori-positive and -negative cases. CONCLUSION: There is no evidence to indicate that H. pylori eradication in duodenal ulcer disease provokes reflux oesophagitis or worsens heartburn; (ii) there are insufficient data to draw firm conclusions about the impact of H. pylori in patients with reflux oesophagitis.     

Review article: Helicobacter pylori infection from pathogenesis to treatment--a critical reappraisal

The main areas of this review are Helicobacter pylori and disease pathogenesis; the relationship of H. pylori to lower gastrointestinal diseases, liver disease and extra-gastrointestinal conditions; the relationship of H. pylori to gastro-oesophageal reflux disease; infection in the very young and very old; diagnostic techniques; and management of H. pylori infections with particular emphasis on eradication regimens and antibiotic resistance.     

大剂量阿莫西林联合艾司奥美拉唑治疗幽门螺杆菌感染患者的疗效

目的分析大剂量阿莫西林联合艾司奥美拉唑治疗幽门螺杆菌感染患者的临床疗效。方法98例幽门螺杆菌感染患者作为研究对象,随机分为观察组与对照组,各49例。对照组采用四联疗法进行治疗,观察组采用大剂量阿莫西林联合艾司奥美拉唑进行治疗。比较两组患者幽门螺杆菌根除率,幽门螺杆菌根除患者复发率,不良反应发生率。结果观察组患者的幽门螺杆菌根除率为95.92%,高于对照组的83.67%,差异具有统计学意义(χ²=4.009,P<0.05)。观察组幽门螺杆菌根除患者的复发率为6.38%,低于对照组的29.27%,差异具有统计学意义(χ²=8.111,P<0.05)。观察组患者的不良反应发生率为8.16%,低于对照组的24.49%,差异具有统计学意义(χ²=4.780,P<0.05)。结论大剂量阿莫西林联合艾司奥美拉唑治疗幽门螺杆菌感染患者的临床疗效较好,可有效提高患者的幽门螺杆菌根除率,降低复发率及不良反应发生率,临床应用价值较高。     

Review article: gastro-oesophageal reflux disease and Helicobacter pylori infection

Gastro-oesophageal reflux disease (GERD) and Helicobacter pylori infection are common conditions that frequently coexist. Controversy continues regarding the role of H. pylori infection in GERD. The results of some studies suggest that eradication of H. pylori may increase the risk for developing GERD, and some experts have suggested that chronic H. pylori infection may be of benefit. This article reviews the data on H. pylori infection and GERD and its treatment.