肝硬化上消化道出血和幽门螺杆菌感染的相关性研究

目的研究肝硬化患者幽门螺杆菌感染和上消化道出血之间的关系.方法肝硬化患者160例,内镜检查了解食管静脉曲张和消化性溃疡的发生情况及出血的原因,同时胃粘膜活检作尿素酶试验,检测幽门螺杆菌(Hp).结果Hp阳性组消化性溃疡发生率(64.1%)明显高于阴性组(37.8%,P＜0.01).出血率在Hp阳性组(38.5%)也明显高于阴性组(22%,P＜0.05).结论Hp感染和肝源性溃疡发生有关,Hp感染者的肝源性溃疡发生率增高及胃粘膜活动性炎症可能导致出血率升高,根除Hp有可能降低肝硬化上消化道出血.     

幽门螺杆菌感染

北京地区老年人群幽门螺杆菌感染的血清流行病学研究；门静脉高压性胃病与幽门螺杆菌感染的关系；^13C-尿素呼气试验检测幽门螺杆菌感染的评价；胃血色素指数的测定对幽门螺杆菌的诊断价值；胆汁反流和幽门螺杆菌感染在胆汁反流性胃炎和消化性溃疡发病中的作用。     

原发性十二指肠胃反流程度与胃黏膜炎性反应关系的研究

目的 分析原发性病理性十二指肠胃反流(DGR)患者胃黏膜病变、幽门螺杆菌(Hp)感染及胆汁反流变化以及相互间的关系.方法 对58例原发性病理性DGR患者进行24 h胃内胆汁监测,以反流时间百分23.60%为界,将患者分为高反流组(29例)和低反流组(29例).并行胃镜检查及胃黏膜活检.分析原发性病理性DGR患者胃黏膜炎性反应、Hp感染、胆汁反流间的关系.结果 高反流组及低反流组的Hp阳性率分别为20.7%(6/29)和48.3%(14/29),差异有统计学意义(P＜0.05).高反流组胃窦和胃角部黏膜肠上皮化生检出率高于低反流组(P＜0.05).胃窦、胃角部黏膜新悉尼系统病理积分Hp阳性组高于Hp阴性组(P＜0.05),高反流组高于低反流组(P＜0.05).Hp阳性组胆红素吸收值≥0.25的时间百分比低于Hp阴性组(P＜0.05),HP阳性组短时间反流频率、长时间反流频率、最长反流时间、吸收值最大值、平均值和中位值与Hp阴性组间差异无统计学意义(P＞0.05).Hp阳性组和阴性组胆红素吸收值≥0.25的时间百分比与胃窦、胃角部黏膜新悉尼系统病理积分均呈正相关(P＜0.05).结论 原发性病理性DGR导致胃窦黏膜损伤的主要因素可能为胆汁反流,胆汁反流可抑制HP在胃内定植,Hp感染可能与胆汁反流协同作用导致胃黏膜损伤.     

胃癌患者中反流性食管炎与幽门螺杆菌感染的相关性分析

目的探讨胃癌患者中反流性食管炎与幽门螺杆菌感染的相关性。 方法选取2015年8月至2017年1月,在新疆维吾尔自治区人民医院就诊的胃癌合并反流性食管炎患者45例与同期在本院就诊的胃癌患者45例,比较两组患者幽门螺杆菌的感染率,并对幽门螺杆菌感染与反流性食管炎进行相关性分析。 结果胃癌合并反流性食管炎组和胃癌患者幽门螺杆菌感染率的发生率分别是22.22%和88.89%,差异有统计学意义（χ²=15.568,P＜0.05）。胃癌合并反流性食管炎组的幽门螺杆菌感染率低于胃癌患者。 结论胃癌患者中幽门螺杆菌感染可能对反流性食管炎发病有一定的保护作用。     

原发性病理性十二指肠胃反流致病的因素分析

目的 探讨原发性病理性十二指肠胃反流(DGR)胃黏膜病变、幽门螺杆菌(Hp)感染、胆汁反流之间的关系.方法 应用便携式胆汁监测仪监测86例原发性病理性DGR患者胃内24 h胆汁反流情况;另取胃黏膜组织活检,分别行快速尿素酶试验、改良Giemsa染色和HE染色,判断有无Hp感染,并观察胃黏膜慢性炎症、活动性、萎缩、肠化等组织学特征.结果 ①将患者根据有无Hp感染分为Hp阳性组和Hp阴性组,Hp阳性组胃窦部黏膜病理积分、胆红素吸收值≥0.25的时间百分比均显著低于Hp阴性组(P均＜0.05);两组胆红素吸收值≥0.25的时间百分比和胃窦、胃角部黏膜病理积分均呈显著正相关(P均＜0.05).②将患者根据胆汁反流程度分为高反流组和低反流组,高反流组Hp阳性率显著低于低反流组(P＜0.05),胃窦和胃角部黏膜肠上皮化生的检出率、胃窦部黏膜病理积分均显著高于低反流组(P均＜0.05).结论 原发性病理性DGR导致胃窦黏膜损伤的主要因素可能为胆汁反流,随胆汁反流程度加重,胃窦黏膜损伤程度加重;胆汁反流可能抑制Hp在胃窦部定植,Hp感染可能与胆汁反流协同作用导致胃体部黏膜损伤.     

幽门螺杆菌感染与消化性溃疡

一、幽门螺杆菌是消化性溃疡的重要病因 (一)流行病学资料:消化性溃疡与幽门螺杆菌感染关系最为密切,95%的十二指肠溃疡以及70%的胃溃疡与幽门螺杆菌感染有关.几项队列研究表明,幽门螺杆菌阳性耆一生中患溃疡病的风险是阴性者的3～10倍[1].     

关于消化性溃疡的产生、复发与幽门螺杆菌感染关系的探讨

目的:探讨老年消化性溃疡发生、复发与幽门螺杆菌(Hp)感染的关系.方法:应用PCR法对68例老年消化性溃疡幽门螺杆菌感染及撤底治疗后6mo,1a对幽门螺杆菌再感染者进行测定.结果:老年组幽门螺杆菌感染率明显高于青年组,Hp治愈率明显低于青年组,Hp撤底根除治疗组溃疡愈合率明显高于未根除治疗组.结论:老年消化性溃疡发生与幽门螺杆菌感染密切相关,在溃疡治疗中,根除Hp感染对减少溃疡复发有密切关系.     

胃幽门螺杆菌感染与口腔异味感关系的相关性研究

目的探讨口腔异味感(俗称口臭)的病因与胃幽门螺杆菌感染的相关性。方法随机选择因上消化道症状就诊于我院消化科(无口腔疾病及全身疾病)的353例患者,首先进行口臭测试,根据有无口臭分为口臭组和无口臭组,所有病例均行13C呼气试验,观察各组中幽门螺杆菌感染率。同时根据有无幽门螺杆菌感染分为感染组和无感染组,观察口臭的发生率。结果353例患者中,口臭组166例,占47.03%,其中胃幽门螺杆菌阳性109例(65.66%);无口臭组187例,占52.97%,其中胃幽门螺杆菌阳性68例(36.36%);两组间差异有统计学意义(χ2=30.19,P0.001),口臭与幽门螺杆菌感染两者间相关系数r=0.29。幽门螺杆菌感染阳性177例,感染率为50.14%,其中口臭134例,占75.71%;幽门螺杆菌检测阴性176例,其中口臭32例,占18.19%;两组间差异有统计学意义(χ2=117.22,P0.001),幽门螺杆菌感染与口臭发生率两者间相关系数r=0.58。结论口臭的病因可能与胃幽门螺杆菌感染有较大的相关性,胃幽门螺杆菌感染有可能是导致口臭的一个原因。     

幽门螺杆菌感染与反流性食管炎相关关系分析

[目的]探讨幽门螺杆菌感染与反流性食管炎的相关关系。[方法]将经电子胃镜检查确诊为反流性食管炎患者90例(反流性食管炎组)及慢性胃炎患者100例(慢性胃炎组),同时经13 C尿素呼气试验法进行幽门螺杆菌检测,对比2组幽门螺杆菌感染情况。将反流性食管炎组患者根据内镜分级标准分为4级,比较各级间的幽门螺杆菌感染情况;根据临床症状程度分为轻、中、重度,比较各程度间的幽门螺杆菌感染情况。[结果]反流性食管炎组幽门螺杆菌感染率(36.7%)明显低于慢性胃炎组(65.0%),差异有统计学意义(P0.01)。反流性食管炎组不同内镜分级及不同临床症状程度者间的幽门螺杆菌感染率比较,差异均无统计学意义(P0.05)。[结论]幽门螺杆菌感染可能在反流性食管炎的发生过程中起保护作用,幽门螺杆菌与反流性食管炎及患者症状程度无相关性。     

幽门螺杆菌感染与胆汁反流

近年幽门螺杆菌与胆汁反流的关系倍受关注，本文就胆汁反流对门螺杆菌感染的影响、幽门螺杆菌根除后胆汁反流是否改变以及胆汁反流对食管、胃粘膜的损害有一综述，提出对于胆汁反流合并幽门螺杆菌感染患者应提倡根除幽门螺杆菌。     

Helicobacter pylori eradication may induce de novo, but transient and mild, reflux esophagitis: Prospective endoscopic evaluation

Backgrounds and Aim:  The effect on reflux esophagitis of eradicating Helicobacter pylori is variable and not fully defined. We previously reported that in patients who have reflux esophagitis associated with duodenal ulcer, a significant improvement in the pre-existing reflux esophagitis occurred after H. pylori was eradicated. In the present study, we asked whether H. pylori eradication leads to de novo development of reflux esophagitis in peptic ulcer patients.
Methods:  Prospective post-eradication evaluations were conducted in 1195 H. pylori -positive patients with peptic ulcer diseases who were confirmed not to have reflux esophagitis by endoscopic examination before eradication therapy. After eradication therapy, endoscopy and a urea breath test were performed yearly.
Results:  A total of 1187 patients were followed for up to 10.0 years (a mean of 3.6 years). Reflux esophagitis developed in 279 of 1000 patients cured of infection and in 26 of 187 patients who had persistent infection ( P  < 0.0001, Fisher's exact test). The esophagitis was mild (Los Angeles grade A) in most patients, transient in approximately one-half, and rarely necessitated long-term medication for the condition. Cure of infection, alcohol consumption, younger age, and high body mass index were identified as significant factors for the risk of developing non-transient reflux esophagitis.
Conclusions:  Cure of H. pylori infection may increase the risk of developing reflux esophagitis in patients with peptic ulcer, but the esophagitis is mostly mild and transient, and long-term medication is rarely required. Thus, H. pylori eradication therapy need not be withheld for fear of provoking reflux esophagitis.     

Ulcer disease and duodenogastric reflux

The intragastric concentrations of lysolecithin and bile acids were determined in 44 chronic peptic ulcer patients and 35 healthy volunteers. Normal reflux values were found in the prepyloric ulcer (Johnson type III) (n = 15) Elevated reflux amounts could be observed in the type I gastric ulcer (n = 15), there was a three-to fourfold increase compared to the controls. - Slightly elevated reflux concentrations were found in the duodenal ulcer patients (n = 14), but only under fasting conditions. The increase of reflux concentration in chronic gastric ulcer type I is shown to be in the same range as in acute stress ulcer. Compared to the three-to four times higher reflux concentrations of the resected stomach, the duodenogastric reflux in ulcer disease is very moderate. It's role in ulcerogenesis has to be analyzed further.     

Effects of bile reflux and intragastric microflora changes on lesions of remnant gastric mucosa after gastric operation

AIM: To investigate the effects of bile reflux and intragastric microflora changes on lesions of remnant gastric mucosa after gastric operation. METHODS: Concentration of bile acid and total bacterial counts (TBC) in gastric juice were measured in 49 patients with peptic ulcer before and after gastrectomy. One year after the operation, sample of gastric mucosa taken from all the patients were used for histological examination. RESULTS: The concentration of gastric bile acid was significantly increased in group B-I, or B-II and SV+A than that in group HSV (P<0.05-0.01). The abnormal histological changes in the remnant gastric mucosa were more common in the first 2 groups than in the last group. CONCLUSION: The type of gastrectomy can affect bile reflux. The abnormal histological changes in the remnant gastric mucosa are closely related to the elevation of bile acid concentration and increase of TBC in gastric juice. HSV can effectively prevent bile reflux and keep the gastric physiological functions stable.     

Measurement of bile acids in fasting gastric aspirates: an objective test for bile reflux after gastric surgery.

We measured the concentration of bile acids in gastric aspirates from patients who had had operations for peptic ulcer. Some patients were asymptomatic and some had postoperative symptoms of the type that have been attributed to duodenogastric reflux. Samples were obtained via a nasogastric tube when the patients were fasting, after food, after pentagastrin, and overnight. We related the concentration and amount of bile acid and the volume aspirated to the presence or absence of symptoms and compared the results with radiological and endoscopic assessments of duodenogastric reflux. The most useful index to discriminate between symptomatic and asymptomatic patients was the amount of bile reflux in half an hour's aspiration from the fasting stomach; this we have termed 'fasting bile reflux' (FBR) and expressed as mumol bile acids refluxing/hour. A figure greater than 120 mumol/h was present in 17 of 22 symptomatic patients and in all who complained of bile regurgitation or bile vomiting. The FBR was less than 120 mumol/h in all of 20 asymptomatic patients, although some of them had reflux detected radiologically and endoscopically.     

十二指肠胃反流和幽门螺杆菌感染关系研究

目的：探讨消化性溃疡患者中的十二指肠胃反流对幽门螺杆菌（Hp)感染的影响。方法：70例消化性溃疡患者，用核素^99MTC-EHIDA测定十二指肠胃反流，胃黏膜Giemsa染色后检测Hp和双抗体夹心ELISA法测定血清Hp-IgG水平。结果：在42例十二指肠胃反流阴性组中，Hp感染率为83．3％（35／42）；28例十二指肠胃反流阳性组中，Hp感染率为39．3％（11／28），两组间Hp感染率差异有显著性（P＜0．05）。而Hp阳性组46例患者中，十二指肠胃反流阳性率为30．4％（14／46）；Hp阴性组24例中，十二指肠胃反流率为58．3％（14／24），两组间十二指肠胃反流率差异也有显著性（P＜0．05）。结论：在消化性溃疡中，十二指肠胃反流对胃内Hp感染可能有抑制作用。     

幽门螺杆菌感染与慢性肝病及肝源性溃疡的相关性研究

目的：探讨慢性肝病患者的幽门螺杆菌（HP）感染情况及HP感染与肝源性溃疡的关系。方法：268例胃镜检查患者同时采用血清学、尿素酶试验、组织学染色行HP检查。结果：慢性肝病患者HP感染率为58．70％,非慢性肝病患者为54．62％（P＞0．05）;肝源性溃疡患者为56．52％,消化性溃疡患者为92．06％（P＜0．05）。轻、中、重三组食管静脉曲张患者溃疡发生率分别为11．11％、43．48％、73．91％。结论：慢性肝病患者HP感染率与非慢性肝病患者无显著性差异;肝源性溃疡患者HP感染率明显少于消化性溃疡患者;食管静脉曲张程度越高,溃疡发生率越高,HP感染不是其主要病因。     

Helicobacter pylori eradication improves pre-existing reflux esophagitis in patients with duodenal ulcer disease.

BACKGROUND & AIMS: There has been significant controversy over the relationship between Helicobacter pylori infection and reflux esophagitis. We investigated the effects of eradicating H. pylori on the reflux esophagitis found in patients with peptic ulcers. METHODS: Prospective posteradication evaluations were conducted yearly in 162 H. pylori-positive patients who had reflux esophagitis together with peptic ulcer disease (4 women and 158 men, mean age = 49.1 yr). The Los Angeles classification of the patients' esophagitis was: grade A, 90; grade B, 63; and grade C, 9. The follow-up evaluations began 1 to 2 months after completion of the eradication treatment (mean time of follow-up = 22 mo), and consisted of endoscopy and an interview focusing on heartburn. RESULTS: Six patients were withdrawn from the study because of adverse drug reactions or a failure to regularly keep their appointments. After eradication therapy, we observed endoscopically that reflux esophagitis had improved in 87 (55.8%) of the 156 patients. The improvement rate was significantly higher in patients cured of infection (60.8%) than in those with persistent H. pylori infection (38.9%) (P = 0.04). Body mass index (odds ratio = 0.86, 95% confidence interval [CI] = 0.76-0.97), cure of infection (3.68, 95% CI = 1.56-8.69), the absence of a hiatal hernia (3.90, 95% CI = 1.83-8.28), and an ulcer located in the duodenum (2.75, 95% CI = 1.33-5.70) were identified as significant independent factors for the improvement of reflux esophagitis. CONCLUSIONS: In patients with reflux esophagitis associated with duodenal ulcer, a significant improvement in pre-existing reflux esophagitis was noted after H. pylori eradication.     

Biphasic radiologic examination and endoscopy of the upper gastrointestinal tract. A comparative study

In this prospective, blind study we compare the diagnostic results of endoscopy with a biphasic radiologic examination with drug-induced hypotony in gastric malignancy, peptic ulcer, and reflux esophagitis. Two hundred fourteen patients underwent both examinations within a week. Both disciplines detected seven malignant tumors. Twenty-three peptic ulcers were found by both; in addition, each diagnosed another ulcer. Fourteen ulcer scars were diagnosed by both; endoscopy demonstrated 10 additional scars and radiology 1. The radiologic examination detected 7 of the 37 cases of endoscopically diagnosed cases of mild reflux esophagitis, 4 of the 7 moderate cases, and 7 of 8 severe ones. A state-of-the-art radiologic examination represents an adequate initial examination in the dyspeptic patient. If the complaints suggest reflux esophagitis, the clinician has to choose between treatment and endoscopy.     

Peptic ulcer and gastritis in uraemia, with particular reference to the effect of Helicobacter pylori infection

AIMS: To determine: (i) the prevalence of histological gastritis and peptic ulcer; and (ii) the clinical features of peptic ulcer, in patients with end-stage renal failure. METHODS: Upper endoscopy was performed by a single observer in 268 patients with end-stage renal failure over a 6-year period. Gastric histology and Helicobacter pylori status were studied in 40 consecutive subjects in whom there were no contraindications for gastric biopsy and who had not used antibacterial drugs in the preceding 4 weeks. As there are only limited data for healthy volunteers in Singapore, 33 age-, sex- and race-matched patients with functional dyspepsia from an earlier drug trial and 18 healthy volunteers who were not age-matched were used as controls. The clinical features of 43 consecutive uraemic patients with peptic ulcer were compared with those of 118 consecutive non-uraemic peptic ulcer patients seen by the same author. RESULTS: Among uraemic patients, histological gastritis was less common, compared with healthy volunteers and functional dyspepsia patients. Helicobacter pylori infection as assessed by histology was also less common among uraemic patients compared with functional dyspepsia patients, but the difference was not statistically significant on serological assessment. Uraemic patients with ulcer had an equal sex ratio, in contrast to a male preponderance among peptic ulcer patients with normal renal function. Uraemic patients with ulcer were more likely to be pain-free, to present with haemorrhage, to have multiple ulcers and postbulbar duodenal ulcers, but were less likely to have H. pylori infection. Among uraemic subjects, the prevalence of H. pylori infection was similar whether or not peptic ulcer was present. CONCLUSIONS: The prevalence of histological gastritis was lower in uraemic patients when compared with patients with functional dyspepsia and healthy volunteers. Peptic ulcers in uraemic subjects have different clinical characteristics from peptic ulcer in non-uraemic subjects.     

Empirical treatment based on "typical" reflux symptoms is inappropriate in a population with a high prevalence of Helicobacter pylori infection

BACKGROUND: Empirical therapy or early endoscopy have been recommended as acceptable management options for GERD. The objective of this study was to determine whether diagnosis and empirical treatment based on reflux symptoms alone are appropriate as initial management for patients with gastroesophageal reflux. METHOD: Consecutive patients presenting with weekly reflux symptoms were evaluated with a structured questionnaire followed by endoscopy. Patients with dyspepsia as the predominant symptom, "alarm" symptoms (weight loss, dysphagia, or bleeding), history of peptic ulcer or gastric surgery, or recent nonsteroidal anti-inflammatory drugs intake were excluded. RESULTS: Four hundred sixty patients were studied: 82 (18%) were found to have peptic ulcer disease and 78 (95%) were infected with Helicobacter pylori. Concomitant erosive esophagitis was found in 26 (32%) of these patients with peptic ulcer disease. In the remaining 378 patients, 218 (58%) had erosive esophagitis and 1 had esophageal cancer. Among the 159 patients with no endoscopic lesion, 148 (93%) had relief of symptoms when treated with a proton pump inhibitor. Multivariate analysis showed that male gender (OR: 1.8, p = 0.03), age greater than 60 years (OR: 2.2, p = 0.01) and H pylori infection (OR: 3.6, p = 0.008) were significantly associated with a diagnosis of peptic ulcer disease. Coexisting dyspeptic symptom was not a predictor (p = 0.13) for peptic ulcer disease. CONCLUSIONS: In populations with a high prevalence of H pylori infection, a significant proportion of patients with GERD have concomitant peptic ulcer disease. Empirical treatment based on "typical" GERD symptoms alone may not be appropriate.