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1.
目的用回顾性对照研究观察根除幽门螺杆菌(HP)能否逆转慢性胃炎胃黏膜萎缩和肠化生的改变。方法选择因慢性胃炎行胃镜检查的病人为研究对象,病理证实有慢性萎缩性胃炎,肠化,HP阳性(美兰染色)的患者符合入选条件,分为HP根除组(76例);HP未根除组(65例),每年做胃镜1次,连续2年以上者。结果在根除HP后1年时胃黏膜萎缩和肠化生的程度较HP未根除病人明显改善,部分病人逆转到正常,在2年时肠化生和萎缩未再进一步改善。结论对于合并胃黏膜萎缩和肠化生的慢性胃炎病人,根除HP治疗对病人可能是有益的。  相似文献   

2.
The predictive value of gastric metaplasia in the duodenal mucosa in patients Helicobacter pylori-positive patients with duodenal bulb ulcer (DBU) was investigated. One hundred and twenty four randomly selected patients with DBU were included in this prospective study. The detection of Helicobacter pylori (HP) in the stomach and duodenum was carried out with Giemsa (using standard visual analogue scale), rapid urease test (standard Jatrox-HP test, Rohm Pharma, Germany), and polymerase chain reaction (PCR) to detect the specific fragment of ureC HP gene (Helicopol II, Lytech, Russia). Regions of gastric metaplasia of the duodenum were confirmed by periodic acid-Schiff and alcian blue (Serva) staining (pH 1.0; 2.5) Duodenal ulcer (DU) complications were registered within 8 to 10 years. Estimation of the predictive factor (gastric metaplasia in the duodenum) was carried out in patients with non-complicated DU (Group 1; n = 73), and with such complications as bleeding, perforation, penetration, pyloroduodenal stenosis (Group 2; n = 51) which were revealed within the 8 to 10 years of observation. Gastric metaplasia in the duodenum was found in 64 or 87.7% of the 73 patients with non-complicated DU and in 5 or 9.8% of the 51 patients with complicated DU within 8 to 10 years of observation. The following facts about the predictive factor for the prognosis of DU complication were found: the sensitivity of 83.6%, the specificity of 92.8%, the predictive accuracy of 88.7%, the relative risk of the predicted outcome of 7.5, the relative risk of a different outcome of 0.11, the odds ration of 65.4. The study revealed a high and significant (p < 0.001) predictive value of gastric metaplasia in the duodenum as a marker of non-complicated clinical course of DU in HP-positive patients within an 8 to 10-year period.  相似文献   

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4.
Sixty-five-years or older person accounts for 23% of the population in Japan. Hence, Helicobacter pylori (H. pylori) eradication therapy is performed in many elderly patients. Urea breath test and H. pylori stool antigen test for diagnosis of H. pylori infection before and after eradication therapy are recommended from the point of being a noninvasive test and providing accurate diagnosis. H. pylori eradication therapy in Japan consists of the PPI/AMPC/CAM as the first therapy, and PPI/AMPC/MNZ as the second therapy. Eradication therapy rate and adverse effect rate of H. pylori eradication therapy for elderly patients are the same as for young people. It is not necessary to avoid H. pylori eradication therapy merely because of high age in elderly patients. However, it is necessary to be careful regarding drug interactions in patients who are taking multiple drugs.  相似文献   

5.
目的 观察不同上消化道疾病患者的幽门螺杆菌(Hp)血清学分型情况,并比较不同Hp分型患者的Hp根除效果。方法 选取因上消化道症状就诊的267例患者作为研究对象,按疾病类型分为慢性胃炎组90例、胃息肉组76例和消化性溃疡组101例。抽取患者静脉血,检测血清Hp抗体表达情况,包括尿素酶A(UreA)、尿素酶B(UreB)、细胞毒素相关蛋白A(CagA)和空泡细胞毒素A(VacA)。比较各组患者的Hp感染率和UreA、UreB、CagA、VacA阳性率。Hp阳性患者均接受四联方案治疗,比较不同Hp分型患者的Hp根除率。结果 267例患者的Hp总感染率为67.04%,慢性胃炎组、胃息肉组、消化性溃疡组的Hp感染率分别为61.11%、51.32%、84.16%;消化性溃疡组的Hp感染率高于慢性胃炎组、胃息肉组,差异有统计学意义(P<0.05),慢性胃炎组与胃息肉组的Hp感染率差异无统计学意义(P>0.05)。消化性溃疡组UreA、VacA阳性率高于慢性胃炎组、胃息肉组,差异有统计学意义(P<0.05);慢性胃炎组UreA、VacA阳性率与胃息肉组相比,差异无统计学意义(P>...  相似文献   

6.
幽门螺杆菌根除后胃黏膜的病理变迁   总被引:2,自引:1,他引:1  
目的探讨根除幽门螺杆菌(Hp)对胃黏膜萎缩、肠上皮化生等癌前病变的转归,以及胃黏膜上皮细胞增殖指标ki-67表达的影响。方法67例Hp感染且有胃黏膜萎缩和(或)肠上皮化生的慢性胃炎患者,随机分为实验组(37例)和对照组(30例),分别给予Hp根除和对症治疗,1年后复查,比较Hp根除与否对胃黏膜萎缩、肠上皮化生等癌前病变的影响;用免疫组化方法检测治疗前后胃黏膜上皮细胞增殖指标ki-67的表达,比较Hp根除与否对它的影响。结果实验组炎症程度减轻(34/37,91.9%,P<0.01),活动性炎症者减少(P<0.01),萎缩、肠上皮化生等癌前病变减轻或逆转(21/32,65.6%vs15/26,57.7%,均P<0.05);ki-67表达降低(46.5±27.7vs15.4±18.7,P<0.01)。结论根除Hp可使胃黏膜炎症程度减轻,活动性炎症消失,萎缩、肠化等癌前病变减轻或逆转,胃黏膜上皮细胞增殖指标ki-67表达减少,从而有利于预防胃癌的发生。  相似文献   

7.
Helicobacter pylori (Hp) was concluded to be 'a definite carcinogen' by WHO/IARC in 1994. We have demonstrated that Hp infection enhances chemical carcinogen-induced stomach carcinogenesis in Mongolian gerbils (MGs) using N-methyl-N'-nitro-N-nitrosoguanidine or N-methyl-N-nitrosourea. Not only well-differentiated but also poorly differentiated and signet ring cell types of cancers are observed, mimicking the human case. Eradication of Hp was found to be effective of preventing enhancing effects. Hp infection alone, without chemical carcinogens, caused submucosal proliferating lesions, but not gastric carcinomas, in contrast to reports that Hp infection alone may act on a complete carcinogen. Precise pathological assessment is required to solve this controversy. Here we demonstrate alleviation of Hp induced gastric lesions with eradication in MGs.  相似文献   

8.
Persistent Helicobacter pylori infection contributes towards the development of chronic gastritis. To clarify the changes in chronic gastritis as a precursor of gastric cancer secondary to H. pylori eradication is an important issue, as it has significant implications for reducing the risk of gastric cancer. Studies published to date, however, are far from consistent with regard to the morphologic changes reported following H. pylori eradication. Of these, some papers reported improvement in gastric atrophy or intestinal metaplasia, versus others reporting no improvement, with the majority of papers published after 2000 reporting improvement in these end points. The inconsistent results concerning the impact of H. pylori eradication on gastric atrophy could be due to the inconsistency of the diagnostic criteria employed for evaluation of the morphology, confounded by the difficulties involved in evaluating atrophic changes in the gastric mucosa. While adherence to the Updated Sydney System available for evaluation of gastritis is primarily required worldwide to ensure consistency in evaluating gastritis, long-term research into the morphologic changes associated with H. pylori eradication is also required to explore strategies for the prevention of gastric cancer with H. pylori eradication.  相似文献   

9.
Persistent Helicobacter pylori infection contributes towards the development of chronic gastritis. To clarify the changes in chronic gastritis as a precursor of gastric cancer secondary to H. pylori eradication is an important issue, as it has significant implications for reducing the risk of gastric cancer. Studies published to date, however, are far from consistent with regard to the morphologic changes reported following H. pylori eradication. Of these, some papers reported improvement in gastric atrophy or intestinal metaplasia, versus others reporting no improvement, with the majority of papers published after 2000 reporting improvement in these end points. The inconsistent results concerning the impact of H. pylori eradication on gastric atrophy could be due to the inconsistency of the diagnostic criteria employed for evaluation of the morphology, confounded by the difficulties involved in evaluating atrophic changes in the gastric mucosa. While adherence to the Updated Sydney System available for evaluation of gastritis is primarily required worldwide to ensure consistency in evaluating gastritis, long-term research into the morphologic changes associated with H. pylori eradication is also required to explore strategies for the prevention of gastric cancer with H. pylori eradication.  相似文献   

10.
Intestinal metaplasia is characterized by Goblet cells and Peneth cells in histological examination. It is frequently observed in gastric mucosa with atrophic gastritis and easily diagnosed using Methylene blue stain in endoscopy. Intestinal metaplasia is seemed to occur during the progression of atrophic gastritis. From our prospective endoscopic follow-up study over 8 years, progression of intestinal metaplasia in gastric body is observed in 44.4% out of 27 H. pylori positive patients. Progression of atrophy is also observed in 37.0% of cases. Development of intestinal metaplasia is also assured in other clinical investigations and experimental studies using Mongolian Gerbils. However, reversibility of intestinal metaplasia after H. pylori eradication is under discussion still now. In our study, we can not observe the regression of intestinal metaplasia even 2 years after successful H. pylori eradication.  相似文献   

11.
Regression of high-grade gastric B-cell lymphoma after eradication of Helicobacter pylori with antibiotic therapy has recently been shown in a very small number of patients. We describe here a patient with a 5-cm polypoid gastric lymphoma, who received a 7-day course of triple therapy when the histopathology was unknown. A second endoscopic examination 4 weeks later showed partial tumor regression without biopsy evidence of malignancy. Endoscopic mucosectomy was performed 8 weeks after the initial diagnosis. Again, in the histological analysis of the specimen, no evidence of B-cell lymphoma could be found. To confirm that the original biopsies were from the same patient, DNA analyses were carried out which gave identical results. This case suggests that a subgroup of primary gastric B-cell lymphomas responds to eradication of H. pylori with antibiotic therapy.  相似文献   

12.
AIM: To study trends in morphological changes of gastric mucosa (GM) and its functional characteristics (serum gastrin-17, pepsinogens I and II) in eradication of Helicobacter pylori (HP) in patients with duodenal ulcer (DU). MATERIAL AND METHODS: HP infection was detected with a rapid urease test, morphological study of gastrobiopsies and polymerase chain reaction in 59 patients with DU. The results of HP eradication were assessed two months after the treatment. Morphological study of gastrobiopsies, assays for gastrin-17, pepsinogens I and II in blood serum were made before the treatment and one year after HP eradication. RESULTS: By the results of eradication two groups were formed: with effective eradication and uneffective eradication of H. pylori. Examination of GM one year after successful H. pylori eradication in DU patients GM inflammation relieved: reduction in polymorphonuclear (by 42.6%), mononuclear (by 29.3%) infiltration and number of lymphocytic follicules (16.8-fold). GM atrophy decreased by 47.8%. In patients with uneffective eradication the above positive changes were not registered. After H. pylori eradication, serum gastrin-17 lowered by 46. 7%, pepsinogen I--by 30.5%, pepsinogen II--by 36.9%. In uneffective eradication this decrease did not occur. CONCLUSION: H. pylori eradication leads to positive changes in morphological and functional indices reflecting GM condition.  相似文献   

13.
H. pylori infection is associated with various gastroduodenal diseases such as gastritis, peptic ulcer, gastric cancer, gastric MALT lymphoma. H. pylori infection is suggested that it plays a role as protective factor not promoting factor for reflux esophagitis and GERD. Epidemiological studies showed lower prevalence of H. pylori infection in reflux esophagitis and Barrett's esophagus comparing the control. Increased occurrence of reflux esophagitis after curing of H. pylori infection was reported. However, the relationship between H. pylori infection and reflux esophagitis has not been actually made clear. Also the mechanism of reflux esophagitis occurrence after H. pylori eradication is not obscure.  相似文献   

14.
In this study 28 patients with Helicobacter pylori-positive duodenal ulcers were treated with a 7-day triple-therapy regimen (omeprazole, clarithromycin, amoxycillin). Gastric emptying time was measured scintigraphically before and after therapy. Only 13 patients attended regularly for their endoscopic and scintigraphic follow-ups. Gastric emptying time was 57.6+/-16.5 min in 28 patients before therapy, and 44.4+/-13.9 min after therapy (44.7+/-7.9 min in the control group). The present study demonstrated gastric emptying time to be longer in the ulcer patients compared with healthy controls and that, after eradication therapy, gastric emptying time became almost normal in the ulcer patients.  相似文献   

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16.
根除幽门螺旋杆菌对功能性消化不良的影响   总被引:2,自引:0,他引:2  
目的 观察中西药结合根除幽门螺旋杆菌(Hp)治疗功能性消化不良(FD)的临床疗效.方法 将Hp阳性FD病人108例随机分为两组,治疗组采用六味安消胶囊加标准三联抗Hp疗法治疗Hp阳性FD病人,对照组仅采用六味安消胶囊加雷贝拉唑治疗.结果 治疗组根除率82.7%,症状改善率及半年持续症状缓解率均优于对照组.结论 Hp阳性FD病人采用中西药结合方法根除Hp治疗,症状明显改善.  相似文献   

17.
目的探讨胃黏膜萎缩伴肠上皮化生与幽门螺旋杆菌(Hp)感染的相关性,旨在为临床治疗提供参考依据。方法慢性萎缩性胃炎伴肠上皮化生患者114例,采用胃镜下钳取组织快速尿素酶试验 (试纸法)和病理检测结果判断是否存在Hp感染。结果胃黏膜萎缩伴肠上皮化生患者中,女性多于男性,胃黏膜萎缩伴肠上皮化生的Hp阳性率为44.7%,肠上皮化生与萎缩程度组之间Hp阳性率差异无统计学意义(P>0.05)。结论Hp感染与慢性萎缩性胃炎及肠上皮化生的发生发展有显著关系,但Hp感染对肠上皮化和胃黏膜萎缩严重程度的影响不明显,可能更多地同年龄、病程相关。对于慢性胃黏膜萎缩伴有肠上皮化生者,如合并Hp感染需要抗Hp治疗及加强监测和定期随访。  相似文献   

18.
Mucosa-associated lymphoid tissue (MALT) lymphomas are localized primarily in the gastrointestinal tract and are characterized by an indolent nature and favorable outcome with specific therapy. Gastric MALT lymphomas are closely linked to Helicobacter pylori (H. pylori) infection, for which eradication therapy is recognized as an effective primary treatment for the disease. However, there is little information about long-term outcomes after the therapy. In the present study, we elucidated the long-term outcomes of 74 patients (70 H. pylori-positive and 4 negative cases) followed up by endoscopy at least 12 months after exclusive eradication therapy alone. The median follow-up period was 46 months. When the remission status was estimated at the time point of 12 months post-eradication, the numbers of patients with complete remission (CR), histologically residual disease with macroscopic normalization (hRD), partial remission with more than 50% tumor reduction (PR) or no response (NR) were 56, 12, 2 and 4, respectively. During follow-ups of over 12 months post-eradication, 11 of the 12 hRD cases were belatedly induced to CR but one CR case histologically relapsed into hRD. One of the 2 PR cases eventually turned into hRD 20 months later. Therefore, 66 CR, 3 hRD, 1 PR, and 4 NR cases (including 3 H. pylori-negative) were identified at the last follow-up of the present study. All 74 patients were followed up without any second-line therapies, but none exhibited disease progression. Thus, the long-term outcome of localized gastric MALT lymphoma after H. pylori eradication therapy was favorable. A watch and wait strategy may be a reasonable approach for hRD since the majority might be in the process of turning into delayed CR.  相似文献   

19.
幽门螺杆菌根除与灭Hp煎剂对慢性胃炎胃黏膜屏障的影响   总被引:2,自引:0,他引:2  
王天轶  姚希贤  刘蕾 《临床荟萃》2006,21(4):246-249,F0003
目的观察幽门螺杆菌(H.pylori,Hp)根除后灭Hp煎剂对慢性胃炎胃黏膜屏障的影响。方法46例Hp( )慢性胃炎患者应用丽珠胃三联根除治疗后,随机分成3组;分别予以灭Hp煎剂、胃复春、氢氧化铝(胃舒平)治疗3个月,治疗前后行胃镜检查,观察药物对慢性胃黏膜病变的治疗情况,同时测定血清表皮生长因子(EGF)和胃窦黏膜磷脂含量以及胃黏膜表皮生长因子受体(EGFR)表达情况。结果单纯Hp根除使各组胃黏膜急性炎症明显消退,但对慢性病变没有影响;灭Hp煎剂治疗后慢性胃黏膜病变明显好转,磷脂含量显著增加,血清EGF从治疗前的(0.45±0.08)μg/L下降至治疗后的(0.36±0.05)μg/L(P<0.05);EGFR表达从治疗前的(35.20±4.95)%增加至治疗后的(48.80±5.19)%(P<0.05),而胃复春组则无明显变化。结论灭Hp煎剂能够增加胃黏膜表面磷脂和血清EGF含量,并使胃黏膜EGFR表达上调,有增强胃黏膜屏障的作用。  相似文献   

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