Chronic inactive gastritis and coccoid Helicobacter pylori in patients treated for gastroesophageal reflux disease or with H pylori eradication therapy

Gastric biopsy specimens from 105 consecutive adults with persistent dyspepsia who did not have changes due to esophageal reflux disease changes or gastric or duodenal ulcers at endoscopy were scored using the updated Sydney gastritis classification system. The medication history of proton pump inhibitors (PPIs) or Helicobacter pylori eradication therapy during the month before endoscopy was retrieved. Of the patients, 72 (68.6%) had chronic inactive gastritis, and 7 (6.7%) had antral-predominant, chronic mild active gastritis. H pylori infection was present in 36 patients (34.3%), of whom 29 had chronic inactive gastritis. Forty-six patients (43.8%) had a positive medication history, including 40 (56%) of 72 with chronic inactive gastritis. The most common morphologic feature associated with H pylori infection was moderate chronic inactive gastritis, which was found most often in patients who had received recent PPIs or H pylori eradication therapy. Pathologists should be aware of the extensive use of these medications, their association with chronic inactive gastritis, and rare H pylori thatfrequently are coccoid shaped. Modified Giemsa stain may not be the optimal method to detect H pylori in this group of patients.     

幽门螺杆菌感染对咽喉反流性疾病的影响

目的 探讨幽门螺杆菌（Hp）感染对咽喉反流性疾病（LPRD）的影响。方法 病例对照研究。纳入2021年7—12月蚌埠医学院第一附属医院耳鼻咽喉头颈外科行电子喉镜检查的咽喉部不适患者181例。其中男51例,女130例,年龄20~71（45.6±10.0）岁。依据反流症状指数（RSI）量表及反流体征评分（RFS）量表评分结果,将患者分为LPRD组95例与非LPRD组86例。纳入性别、年龄、Hp感染、吸烟、饮酒、甜食、辛辣饮食等因素进行单因素分析,将其中P<0.05的因素进一步采用多因素logistic回归分析;比较Hp阳性与Hp阴性LPRD患者的RSI、RFS评分差异。结果 单因素分析结果显示,Hp感染是LPRD的影响因素,差异有统计学意义（χ²=6.34,P=0.012）。多因素logistic回归分析显示,Hp感染是LPRD的独立危险因素（比值比=2.190,95%可信区间1.184~4.059, P=0.012）。LPRD组中,Hp阳性患者的RSI、RFS评分分别为（25.28±2.81）、（16.47±2.96）分,Hp阴性患者分别为（17.56±2.69）、（12.70±2.05）分,2组比较差异均有统计学意义（t=12.45、7.04,P值均<0.001）。结论 Hp感染是LPRD发病过程中的独立危险因素,可进一步加重LPRD患者的症状及体征。     

胃食管反流病的病理诊断问题

胃食管反流病(gastroesophageal reflux disease)是消化系统的常见病之一,不同年龄人群包括儿童和婴儿均可发生.欧美国家发病率很高,美国成年人的发病率达14%～20%[1-2).近几十年来,亚洲各国发病率呈明显增高的趋势,我国成人发病率为2.95%～6.20%[3-4].     

胃食管反流病的病理诊断问题

胃食管反流病(gastroesophageal reflux disease)是消化系统的常见病之一,不同年龄人群包括儿童和婴儿均可发生.欧美国家发病率很高,美国成年人的发病率达14%～20%[1-2).近几十年来,亚洲各国发病率呈明显增高的趋势,我国成人发病率为2.95%～6.20%[3-4].     

Pharmacogenomical aspects of gastroesophageal reflux disease

The article covers the modem concept of gastroesophageal reflux disease (GERD) pharmacogenomics. Special attention is payed to polymorphism of CYP2C19 gene and its influence on the metabolism of modern antisecretory agents, such as proton pump inhibitors (PPI). The authors summarize data which demonstrate that the differences in the pharmacodynamics and clinical effects of PPI are caused by CYP2C19 gene polymorphism. The paper shows that this factor should be considered when planning GERD therapy with PPI in order to achieve a complete remission and make the therapy economically rational.     

Helicobacter pylori & gastric disease

Since the discovery of Helicobacter pylori(H. pylori), causal linkage between H. pylori infection and some of gastric disease has been generally accepted from the results of many studies. Indeed the usefulness of H. pylori eradication therapy for acute gastritis, peptic ulcer, gastric polyp and MALT lymphoma etc. has been reported. In the low grade MALT lymphoma, the regression rate by this therapy is about 70%. On the other hand, we should pay the caution to several adverse effects, such as drug resistance and GERD, of H. pylori eradication therapy. However, based on the several results of comparative studies between antibiotic therapy and the other one, the antibiotic therapy for peptic ulcer is only covered by national health insurance at present. The reversibility of gastric precancerous conditions such as mucosal atrophy, intestinal metaplasia and dysplasia by antibiotic therapy has been studied, but its significance is not clear yet. In animal experiment, H. pylori infection induced gastric adenocarcinoma in Mongolian Gerbils. However, this phenomenon is limited to this kind of animal only. To proof the causal link between H. pylori infection and genesis of gastric cancer in human being, clinical intervention trials are ongoing in the world. If these trials can clarify it, the H. pylori eradication therapy will be established as preventive measure for gastric carcinogenesis.     

Clinicomorphological diagnosis and surgical treatment of complicated gastroesophageal reflux disease

Biopsy and surgery specimens taken from 224 patients with gastroesophageal reflux disease were clinically and morphologically analyzed. The morphological diagnosis of this condition is of more informative value than endoscopy and X-ray study. Malignization occurs in 25% of patients with Barrett oesophagus. One case of surgical treatment for gastroesophageal reflux disease yielding a good outcome is described.     

Air column in esophagus and symptoms of gastroesophageal reflux disease

Background

During imaging of the normal esophagus, air is often detected. The purpose of this study was to determine the correlation between the appearance of air bubbles on imaging and Gastroesophageal Reflux Disease (GERD) symptoms.

Methods

The cross-sectional imaging study was conducted at Rasole Akram Hospital, Tehran, Iran. A total of 44 patients underwent X-ray computed tomography (CT) scanning; the presence of air in the esophagus and visible on CT imaging was scrutinized.

Results

The average age of the subjects was 59 and the male to female ratio was 0.83. We found a significant relationship between the presence of GERD symptoms, the size of air bubbles and esophageal dilation (ED) on the CT scan.

Conclusions

Air bubbles in the esophagus may be seen frequently in CT scans, but their size and location can vary. The GERD symptoms can arise when a small diameter air column is present within the esophagus, especially in the middle and lower parts.     

Role of corpus gastritis and cagA-positive Helicobacter pylori infection in reflux esophagitis

Considering that the role of Helicobacter pylori infection in gastroesophageal reflux and reflux esophagitis (GERD) is still controversial and that the role of virulence markers of the bacterium has not been evaluated in most studies of GERD, we investigated the association among H. pylori infection with cagA-positive and -negative strains, corpus gastritis, and GERD in a large group of patients by controlling for confounding factors. We studied prospectively 281 consecutive adult patients: 93 with GERD and 188 controls. H. pylori infection status was diagnosed by culture, by the preformed urease test, with a carbolfuchsin-stained smear, and by histology. The cagA status was determined by PCR of H. pylori isolates and gastric biopsy specimens. H. pylori infection was diagnosed in 191 (68.0%) of 281 patients. Among the 93 patients with GERD, 84 presented with mild or moderate esophagitis and 9 presented with severe esophagitis. In the multivariate analysis, the age of the patients and the degree of oxyntic gastritis were associated with GERD. Among the strains isolated from patients with GERD and from the control group, 24.4 and 66.9%, respectively, were positive for cagA (P < 0.001). Compared to infection with cagA-negative strains, infection with cagA-positive H. pylori strains was associated with a more intense gastritis in the corpus (P = 0.001). cagA status (odds ratio [OR] = 0.16, 95% confidence interval [CI] = 0.07 to 0.40), gastritis of the corpus (OR = 0.69, 95% CI = 0.48 to 0.99), and age (OR = 1.04, 95% CI = 1.01 to 1.07) were associated with GERD. In conclusion, the study provides evidence supporting the independent protective roles of cagA-positive H. pylori strains and the degree of corpus gastritis against GERD.     

非糜烂性反流病患者胃食管交界顺应性增加

目的揭示非糜烂性反流病(NERD)的生物力学机制。方法纳入自2014年10月4日至2015年9月30日就诊于中日友好医院消化内科门诊符合NERD诊断的17例患者及健康志愿者17名。使用内镜联合Endo Flip技术对胃食管交界的横截面面积(CSA)、球囊内压力和顺应性(Δv/Δp)进行测定。结果随球囊容积增加,胃食管交界处的顺应性NERD组显著高于对照组(P0.01),而横截面积和球囊内压力变化不明显。结论非糜烂性反流病患者的胃食管交界的顺应性增加可能是其重要的发病机制之一。     

Ebstein's anomaly and gastroesophageal reflux

Ebstein''s anomaly with gastroesophageal reflux is rare. The author presents two instances of this rare entity.     

Helicobacter pylori infection in sickle cell disease

Abdominal pain is a common presenting symptom in adults with sickle cell disease (SCD). One case of Helicobacter pylori gastritis has been reported in a child with sickle cell anemia. H. pylori-induced peptic ulcer disease (PUD) has not previously been reported in adults with SCD. We report eight cases of H. pylori infection in adult sickle cell patients presenting with acute or recurrent abdominal pain and/or gastrointestinal bleeding. In all cases, H. pylori serology (IgG) was positive, and three patients had gastric or duodenal ulcer by endoscopic examination. All patients responded to H. pylori treatment with complete resolution of symptoms by 4 weeks. The prevalence of H. pylori infection in SCD is unknown, but patients may be at increased risk for H. pylori-induced PUD and complications due to pre-existing anemia, increased nonsteroidal anti-inflammatory drug use, and alloimmunization which may delay necessary transfusion. It is important that the differential diagnosis of abdominal pain in adults with SCD include nonsickle cell-related disorders such as PUD. When confirmed, a definitive etiology of PUD must be determined so that appropriate treatment strategies can be initiated promptly and excess morbidity avoided.     

Dental approach to erosive tooth wear in gastroesophageal reflux disease

Background

The duration of gastro-esophageal reflux disease (GERD), the frequency of reflux, the pH and type of acid, and the quality and quantity of saliva affect the severity of dental erosion due to GERD.

Objective

To summarize the diagnostic protocol and treatment of dental erosion due to GERD.

Methods

A Medline literature search was performed to identify articles associated with a dental approach to GERD.

Results

The dental professional must carry out a diagnostic protocol, which includes collecting data on the patient''s medical and dietary history, occupational/recreational history, dental history, and oral hygiene methods. Intraoral, head and neck, and salivary function examinations should be performed to expose the dental implications of GERD symptoms.

Conclusion

Diagnosing the cause of erosive tooth wear can help prevent further damage. Patients must be informed about how to prevent GERD.     

改善行为方式对胃食管反流病的治疗作用

目的探究行为方式的改善对胃食管反流病的治疗作用。方法入选102例胃食管反流病患者随机分为两组,其中对照组（51例）予以常规药物治疗,研究组（51例）在药物治疗的基础上加用行为方式的干预。治疗8周后,分析比较两组患者的相关临床资料。结果治疗8周后,研究组患者在反酸、胸骨后疼痛、烧心、食管反流、嗳气、吞咽不适等症状方面有显著的改善（P〈0.05）,内镜下分级情况也有显著的改善,并且与对照组相比较,效果更明显（P〈0.05）。对照组的总有效率为78.53%,研究组的总有效率为94.12%,两组之间具有统计学差异（P〈0.05）。结论行为方式的改善对胃食管反流病具有显著的治疗效果,既经济又简单易行。