幽门螺杆菌感染、胃上皮内瘤变与结直肠腺瘤的相关性

[目的]探讨幽门螺杆菌(Helicobacter pylori,Hp)感染、胃上皮内瘤变(gastric intraepithelial neoplasia, GIN)与结直肠腺瘤(colorectal adenomas, CRA)之间的相关性。[方法]通过纳入标准、排除标准及筛除资料不全者,纳入397例患者作为研究对象。所有研究对象均在同一次住院期间完成胃肠镜检查及组织病理学检测、Hp检测(包括¹⁴C-尿素呼气试验或胃黏膜组织银染色法),同时收集患者的基础资料、实验室检查等数据。应用SPSS 25.0统计软件,对所收集的数据进行统计和分析,通过计算OR值和95%CI分析Hp感染、GIN与CRA的相关性。[结果]Hp感染的患者罹患CRA的风险升高(原始OR=1.796,95%CI:1.100～2.935,P=0.019;矫正后OR=1.793,95%CI:1.043～2.900,P=0.034),GIN的患者罹患CRA的风险升高(原始OR=2.362,95%CI:1.226～4.551,P=0.010,矫正后OR=1.912,95%CI:1.025～3.567,P...     

胃黏膜低级别上皮内瘤变的胃复春联用叶酸治疗及转归研究

目的：探讨胃复春联用叶酸治疗胃黏膜低级别上皮内瘤变及临床转归。方法：收集上海市7所不同等级医院2011年1月至2011年12月经胃镜活组织检查（活检）病理证实的胃黏膜低级别上皮内瘤变患者共198例,应用胃复春联用叶酸的方案进行药物治疗,并进行定期随访及内镜复查,符合指征者行内镜或外科手术治疗及病理学检查,了解其疗效、转归及胃癌漏诊情况。结果：胃黏膜上皮内瘤变病灶主要位于胃窦（66.7%）,镜下表现多样,主要为粗糙糜烂（37.9%）。药物治疗后患者临床症状总改善率为76.3%。最终随访结果显示,胃黏膜上皮内瘤变病灶完全消退47例（23.7%）,病理消退72例（36.4%）,不变55例（27.8%）,进展22例（11.1%）及腺瘤样变2例（1.0%）,总消退率为60.1%。进展患者中符合漏诊者达50.0%。结论：胃复春联用叶酸能有效缓解胃黏膜上皮内瘤变患者的临床症状,部分消退低级别上皮内瘤变。对低级别上皮内瘤变患者进行定期胃镜随访有望早期检出胃癌病灶,部分胃黏膜上皮内瘤变同时存有癌变病灶,内镜短期、重复检查可减少胃癌漏诊率。     

光学活检与组织病理对胃黏膜上皮内瘤变的诊断价值

[目的]了解共聚焦激光显微内镜（confocal laser endomicroscopy,CLE）对胃黏膜低级别上皮内瘤变的应用前景及诊断价值。[方法]对195例隆起糜烂性胃炎伴黏膜粗糙患者进行分组,分别采取普通内镜下活检及CLE指导活检,比较2组的诊断率,病理诊断为金标准对共聚焦结果进行评价。[结果]CLE组诊断率明显高于常规内镜组（P〈0.05）,对比病理检查共聚焦诊断的敏感性为86.36%,特异性为95.83%。[结论]CLE在胃黏膜低级别上皮内瘤变诊断中具有重要价值,为提高诊断效率提供了新方法。     

结直肠高级别上皮内瘤变的临床分析38例

目的:研究结直肠高级别上皮内瘤变的临床病理特征,探讨临床合理治疗决策.方法:回顾性总结38例经内镜检查和病理初步诊断为结直肠高级别上皮内瘤变患者的,临床资料,分析其临床表现、内镜形态学、组织病理学特点、预后等,随访观察3-36 mo.结果:38例患者中,最终确诊17例为结直肠癌.21例仍为高级别上皮内瘤变.治疗前后诊断一致性较差(Kappa值为0.376).结直肠高级别上皮内瘤变合并癌的高危因素包括:肿瘤大小、内镜形态特点、症状严重、绒毛状腺瘤合并高级别上皮内瘤变、CEA或CA19-9增高等.结论:使用WHO新的诊断结直肠高级别上皮内瘤变需引起临床医生重视,特别是对于内镜下单纯活检病例.应当谨慎选择治疗方式和随访时间.     

老年患者幽门螺杆菌感染与胃炎活动性相关性分析

目的探讨老年患者幽门螺杆菌(Hp)感染与胃炎活动性的相关性。方法回顾性地分析2014年1月至2014年6月于北京老年医院接受胃镜及~(13)C呼气试验检查的良性上消化道疾病患者278例,依据年龄分为年龄≥60岁(老年组)111例和年龄60岁(非老年组)167例,分别观察两组患者Hp感染情况及胃黏膜组织中性粒细胞浸润与Hp感染的关系。结果老年组与非老年组比较,Hp感染率分别为27.0%(30/1 11)和36.5%(61/167),差异无统计学意义(P0.05);中性粒细胞浸润率分别为18.9%(21/111)和29.3%(49/118),差异无统计学意义(P0.05);Hp阳性和Hp阴性患者中性粒细胞浸润分别为70.3%(64/91)和3.2%(6/187),差异有统计学意义(P0.05);Hp阳性患者老年组和非老年组中性粒细胞浸润分别为63.3%(19/30)和73.8%(45/61),中性粒细胞浸分级(轻、中、重)分别为26.3%vs 17.8%,57.9%vs 71.1%,15.8%vs11.1%,差异均无统计学意义(P0.05)。结论胃黏膜急性炎症与Hp感染相关,急性炎症分级与感染年龄无关。     

胃食管连接部低级别上皮内瘤变内镜黏膜下剥离术后与术前病理比较分析

目的 探讨胃食管连接部低级别上皮内瘤变（low-grade intraepithelial neoplasia,LGIEN）的治疗方案。方法 收集我院2013年1月至2017年6月经胃镜活检病理检查证实胃食管连接部LGIEN的61例患者,行内镜黏膜下剥离术（endoscopic submucosal dissection,ESD）,进行术前与术后病理结果比较分析。结果ESD术后病理诊断炎症6例,LGIEN26例,HGIEN18例,早期胃食管连接部癌11例。术前诊断过度率9.84%（6/61）,术前术后病理一致率42.62%（26/61）,术前诊断不足率47.54%（29/61）,早期癌漏诊率18.03%（11/61）。病灶＜10mm者术前诊断不足率32.43%（12/37）,病灶≥10mm者术前诊断不足率70.83%（17/24）。结论 由于胃食管连接部位置特殊,病灶分布不均,易造成取检偏差,胃镜活检不能全面反映病灶真实情况。另外随着病灶面积增大其术前诊断不足率增加,早期癌漏诊率增加。胃食管连接部低级别上皮内瘤变应尽早ESD干预治疗,既能获得完整病理,完善检查,避免早癌漏诊,又能减轻患者心理负担。     

ESD治疗中低位直肠上皮内瘤变的临床研究

[目的]探讨内镜黏膜下剥离术（endoscopic submucosal dissection,ESD）对中低位直肠的高或低级别上皮内瘤变的治疗价值.[方法]回顾性分析成都军区总医院消化内镜中心进行ESD治疗的29例中低位直肠的高或低级别上皮内瘤变患者的临床资料,分析其术中及术后并发症情况、病理结果、术后症状改善、随访情况.[结果]切除病灶大小1.2 cm×2 cm～3 cm×4 cm,平均2 cm× 2.3 cm,操作时间50～180 min,中位时间95 min.并发穿孔2例（6.9％,2/29）,经内镜下处理得到控制;所有病灶均一次性整块切除,治愈性切除率93.1％（27/29）;术后无迟发性穿孔,迟发性出血率10.3％（3/29）,但量均较少,经保守治疗得到控制;术后病理示低级别上皮内瘤变16例（55.2％,16/29）;高级别上皮内瘤变13例（44.8％,13/29）.术后平均住院日7d,排便控制功能良好.随访3～36个月,无局部复发.[结论]ESD是治疗中低位直肠的高或低级别上皮内瘤变的有效方法之一,符合现代人们既切除病灶又保留功能、提高生存质量、微创的要求.     

基于窄带成像和放大内镜的诊断模型在分类结直肠腺瘤中的价值

目的 结直肠腺瘤是一种常见的胃肠道疾病,结肠镜检查被认为是检出结直肠腺瘤的主要工具。本研究拟建立一套人工智能(AI)辅助的图像诊断系统,该系统具有预测腺瘤上皮内瘤变等级的功能。借助窄带成像(NBI)或放大内镜结合NBI(ME-NBI)的帮助,该系统最终将有利于提高结肠镜检查中对腺瘤诊断的准确性,提升工作效率。方法 收集2015.10-2021.10期间,北京清华长庚医院消化内镜中心的结直肠腺瘤病例,筛选出具有代表性的763名患者,组成数据集,其中包含1049张标记的图像用于训练模型。改进和训练深度卷积神经网络,对结肠镜检查中的腺瘤进行分类。在临床验证阶段,使用一个独立的数据集,包括100张图像来测试AI诊断系统的能力。将研究对象分为五组：AI诊断系统、非内镜专家、内镜专家、非内镜专家+AI、内镜专家+AI。这五组需要逐一识别所有的NBI和ME-NBI图像,并将结论与组织病理学诊断进行比较。所有数据输入统计软件SPSS 20中进行分析,P<0.05为有统计学差异。结果 在标记图像上测试时,AI诊断系统对腺瘤的分类能力已经得到证实,曲线下面积(ROC)为0.895,平均精度(mAP)...     

幽门螺旋杆菌感染与结直肠腺瘤复发的相关性分析

背景结直肠腺瘤(colorectal adenoma, CRA)是结直肠癌(colorectalcancer,CRC)的癌前病变,早期切除及预防其复发是预防结肠癌的有效措施.但腺瘤切除后容易复发,有研究显示幽门螺旋杆菌(Helicobacter pylori,H. pylori)感染是CRA发生原因之一,本研究拟分析H.pylori感染及根除H. pylori对CRA复发的影响.目的探讨CRA术后复发的危险因素,尤其是H. pylori感染对CRA复发的影响.方法收集本院门诊及病房行肠镜检查并病理证实为CRA的病例,根据13C呼气试验结果,将其分为A组(H. pylori阴性组)和B组(H. pylori阳性组); B组病例再随机分成两组:C组根除H. pylori, D组未根除H. pylori. 1年后复查肠镜及呼气试验,根据随访肠镜的结果,比较息肉复发病例和未复发病例的一般资料,并对CRA复发的危险因素进行Logistic回归分析.结果共有733例CRA患者纳入本研究,各组中患者的一般资料以及术前息肉的大小、数目、病理类型及手术方式等均无显著差异(P0.05).术后1年复查, H. pylori感染组(B组)患者息肉复发率显著高于A组(23.02%vs15.79%, P 0.05);而根除H. pylori后的C组息肉复发率则显著低于未根除的D组(17.37%vs 28.36%, P0.05).在息肉复发的所有危险因素中,男性患者、BMI≥25kg/m2,息肉个数≥3枚、息肉大小≥20mm及H. pylori感染等因素存在统计学差异(P0.05); Logistic回归分析显示, H. pylori感染是息肉复发的独立危险因素(OR=1.556, P 0.05),而根除H. pylori与息肉的复发呈负相关性(OR=0.509, P0.05).结论H. pylori感染会增加CRA的复发,是CRA术后复发的独立危险因素,根除H. pylori后能显著降低CRA的复发.     

结直肠息肉、结直肠癌的特点及与幽门螺杆菌感染相关性的研究

目的 探讨结直肠息肉、结直肠癌临床与病理的特点及其与幽门螺旋杆菌(Helicobacter pylori,H.pylori)感染的相关性.方法 收集安徽医科大学第二附属医院2018年7月至2020年9月同时行肠镜及幽门螺旋杆菌血清学抗体检测的患者资料共460例,并分为结直肠息肉组、结直肠癌组、正常对照组,回顾性分析结直...     

Helicobacter pylori infection concomitant with metabolic syndrome further increase risk of colorectal adenomas

AIM: To investigate the association of colorectal adenomas with both Helicobacter pylori (H. pylori) infection and metabolic syndrome. METHODS: Using a cross-sectional hospital-based study, we analyzed physical examination data from 9311 healthy subjects with overnight physical examinations performed between January 2004 and December 2006. Examined data included gender, age, life style, anthropometric measurements, blood pressure, biochemical and hematological studies, H. pylori infection detected by esophagogastroduodenoscopy and biopsy urease tests, and colorectal adenomas detected with a complete total colonoscopy. RESULTS: The prevalence values for H. pylori infection, metabolic syndrome, and colorectal adenoma were39.2%, 18.7%, and 20.7%, respectively. Colorectal adenoma risk factors included male gender [odd ratio (OR): 2.005, 95% conf idence interval (CI): 1.740-2.310, P < 0.001], advanced age (OR: 1.046, 95% CI: 1.040-1.052, P < 0.001), smoking (OR: 1.377, 95% CI: 1.146-1.654, P = 0.001), increased body fat (OR: 1.016, 95% CI: 1.007-1.026, P = 0.001), higher white blood cell count (OR: 1.038, 95% CI: 1.005-1.073, P = 0.025), H. pylori infection (OR: 1.366, 95% CI: 1.230-1.517, P < 0.001), and metabolic syndrome (OR: 1.408, 95% CI: 1.231-1.610, P < 0.001). In addition, concomitant H. pylori infection with metabolic syndrome further increased the probability of colorectal adenomas. CONCLUSION: Our study revealed H. pylori infection with concomitant metabolic syndrome might further increase the risk of colorectal adenomas.     

Helicobacter pylori infection and increased diabetes prevalence were the risks of colorectal adenoma for adults: A systematic review and meta-analysis (PRISMA-compliant article)

Background:Helicobacter pylori infection and hyperglycemia are associated with an increased risk of colorectal neoplasm, and may have a synergistic effect in combination. However, these 2 factors that affect colorectal neoplasm remain controversial. We aimed to carry out a meta-analysis to evaluate the study population diabetes prevalence rate and H pylori infection rate with colorectal adenoma risk for adults.Methods:We conducted systemic research through English databases for medical reports. We also recorded the diabetes prevalence and H pylori infection prevalence in each study. We classified these studies into 4 subgroups as their background population diabetes prevalence <6% (Group 1); between 6% and 8% (Group 2); between 8% and 10% (Group 3), and more than 10% (Group 4). The random-effects model had used to calculate pooled prevalence estimates with 95% confidence interval (CI).Results:Twenty-seven studies were finally eligible for meta-analysis. The random-effects model of the meta-analysis was chosen, showing pooled odds ratio (OR) equal to 1.51 (95% CI 1.39–1.63). The subgroup meta-analyses showed in Group 1 the H pylori infection associated colorectal adenoma risk OR was 1.24 (95% CI 0.86–1.78). As the diabetes rate exceed 6%, the H pylori infection became the more significant increased risk of colorectal adenoma (Group 2: OR 2.16 (95% CI 1.61–2.91); Group 3: OR 1.40 (95% CI 1.24–1.57); and Group 4: OR 1.52 (95% CI 1.46–1.57)).Conclusions:The results of this meta-analysis showed elevated diabetes prevalence combined H pylori infection increasing the risks of colorectal adenoma in the adult population.     

Helicobacter pylori infection increases the risk of colorectal adenoma and adenocarcinoma, especially in women

Background Recent reports suggest that Helicobacter pylori infection can potentially increase the risk of colorectal cancer. The purpose of this study was to assess the association between H. pylori infection and the risk of colorectal adenoma and adenocarcinoma, and to evaluate any differences on the basis of sex. Methods The subjects were 669 (40- to 80-year-old) patients who underwent both barium enema examination and total colonoscopy, and who were evaluated for H. pylori infection by ¹³C-urea breath test, urease test, or histological diagnosis of biopsied gastric specimens. There were 142 H. pylori-negative and 527-positive patients. The odds ratios (ORs) for H. pylori-positive patients with colorectal adenoma and adenocarcinoma, and for tumor patients with either adenoma or adenocarcinoma were calculated. Results Among the H. pylori-negative patients, there were 52 patients without tumor, 63 with adenoma, 27 with adenocarcinoma, and 90 with tumor. Among the H. pylori-positive patients, there were 136, 264, 127, and 391 patients respectively. Pooling all subjects, those infected with H. pylori had a significantly increased OR for adenoma, adenocarcinoma, or tumor, compared to H. pylori-free patients (OR, 1.60, 1.80, and 1.66, respectively). For female H. pylori-positive subjects, the risk of having adenocarcinoma or tumor was significantly higher than that for their H. pylori-free counterparts, while for male H. pylori-positive and -negative subjects, there was no such significant difference. Conclusions The results therefore suggest that, in patients aged 40–80 years, H. pylori infection increased the risk of colorectal adenoma and adenocarcinoma, with significantly higher risks for female patients.     

Helicobacter pylori infection in Icelandic children

Objective: The prevalence of Helicobacter pylori (HP) infection is decreasing in the western world. The seroprevalence among 25–50-year-old Icelandic adults was recently shown to be 30–40%. Information on the seroprevalence in Nordic children is limited. We aimed at ascertaining the infection prevalence among healthy Icelandic children.

Methods: The infection status in stored frozen blood samples from two cross-sectional studies on the health of 7–9-year-old children (n?=?125) and 16–18-year-old adolescents (n?=?80) was determined by enzyme-linked immunosorbent assay (ELISA). Information on family demographics and GI symptoms was obtained by standardized questionnaires.

Results: Overall, 3.4% (7/205) of the children were infected with H. pylori. The prevalence was 2.6% (5/190), missing data n?=?3, among children with both parents born in a low prevalence country compared to 17% (2/12) among those with at least one parent born in a high prevalence area (p?=?.026). When at least one parent was born in a high prevalence country, the odds ratio for being H. pylori seropositive was 2.2 (95% CI, 1.02–54.67), when adjusted for the educational status of the mother. There was no significant association between H. pylori infection and gastrointestinal symptoms.

Conclusion: Prevalence of H. pylori infection in Iceland has become very low, suggesting a great reduction in transmission from older generations. There was an association between H. pylori infection and origin from high prevalence areas but not with gastrointestinal symptoms. The results mirror recent studies of children of Scandinavian ancestry.     

Helicobacter pylori infection in children

Helicobacter pylori was sought prospectively by culture of antral biopsy, histology and serology (IgG and IgA) in 440 consecutive endoscopies on children to determine the prevalence, clinical presentation and histological features of H. pylori infection in our population. Twenty-eight patients had H. pylori (8% overall). The mean age of infected patients was significantly higher than that of non-infected patients (P less than 0.0001). No patient under 5 years of age had H. pylori isolated. Overall, there was no significant difference in clinical presentation between those with and those without H. pylori infection, but 23% of patients 5 and 26 years of age who presented with abdominal pain as the indication for their endoscopy had H. pylori isolated. Macroscopic changes ranged from no abnormality to frank ulceration, but the typical antral mamilliform changes were 100% predictive of infection. Fifty-eight per cent of patients with duodenal ulcers, but only 17% with gastric ulcers had H. pylori infection. Histological gastritis was present in 144 patients (including all H. pylori positive patients). None of the patients with another definable cause for gastritis had H. pylori isolated. In conclusion, H. pylori is an important cause of primary gastritis in our population, occurring in children over 5 years of age. Culture of an antral biopsy should be performed in children over this age undergoing endoscopy for the investigation of abdominal pain and, more particularly, in those with peptic ulceration.     

山东和北京地区幽门螺杆菌感染的流行病学研究

目的 探讨中国胃癌高发区山东牟平和低发区北京延庆儿童及成人幽门螺杆菌(H.pylori,Hp)感染现状及变化.方法 2006年5-7月检测两地区8～15岁儿童和40～79岁成人2065例.收集同地区90年代初资料及1991年和2006年于我院进行胃镜检查的所有病例11 656例,分析Hp感染率变化.结果 牟平儿童和成人Hp阳性率分别为37.69%和50.95%,显著高于延庆儿童和成人的25.58%和41.35%(P<0.01).与1991年相比,2006年牟平儿童Hp阳性率下降显著(P<0.001),而延庆儿章下降无统计学意义(P>0.05).两地区成人HP阳性率均显著下降(P<0.01).我院病例Hp感染率下降显著(P<0.001).结论 胃癌高发区儿童和成人Hp感染率显著高于胃癌低发区,Hp感染可能是胃癌发生的危险因素之一.近十多年来Hp感染率在中国人群中有下降趋势.     

幽门螺杆菌感染与反流性食管炎的关系

目的探讨幽门螺杆菌（Hp）感染与反流性食管炎（RE）的关系。方法对在本院消化科就诊的患者行内镜下快速尿素酶测定却感染，观察比较却阴性组、却阳性组RE的发病率。对却阳性组中经胃镜及病理切片证实为消化性溃疡的患者，进行却根除治疗，3个月后复查胃镜比较抗却治疗前后RE发病率的变化。结果却阳性组RE发病率为5．28％，却阴性组RE发病率为7．59％，二者差异有统计学意义（P〈0．05）。抗却治疗前后RE发病率分别为10．7％、35．7％，二者差异有统计学意义（P〈0．05）。结论①却不是RE的病因；②抗坳治疗会导致RE发病率的升高。     

粪便抗原检测诊断幽门螺杆菌现症感染

目的 评价应用免疫酶联吸附试验(ELISA)检测粪便中幽门螺杆菌(Helicobacter pylori)抗原诊断H.pylori现症感染的敏感性和特异性。方法 应用^14C呼气试验以及幽门螺杆菌粪便抗原(HpSA)试验，对100例因上消化道不适就诊，怀疑有H.pylori感染的患者进行检测，观察两种检查的符合率。结果 ^14C呼气试验和HpSA同时阳性者38例，^14C呼气试验阳性而HpSA阴性者4例；^14C呼气试验和HpSA同时阴性者57例，^14C呼气试验阴性而HpSA阳性1例。以^14C呼气试验作为金标准计算，HpSA检测方法的敏感性为90．48％，特异性为98．28％。结论 幽门螺杆菌抗粪便原检测与^14C呼气试验有较高的符合率，而且简便易行，不需特殊设备，解决了无法进行呼气试验的婴幼儿和有肺部疾患者的非侵人性幽门螺杆菌现症感染诊断问题，是一种非侵入性幽门螺杆菌现症感染诊断的新方法。