幽门螺杆菌与门脉高压性胃病

随着急诊胃镜的广泛开展,发现肝硬化门脉高压症并上消化道出血的原因中,非食管胃底曲张静脉破裂的因素逐渐增加。食管胃底曲张静脉破裂为出血主要原因,门脉高压性胃病和胃、十二指肠溃疡是肝硬化门脉高压症的常见合并症,也是引起上消化道出血的重要原因之一。门脉高压性胃病(portal hypertensive gastropathy,PHG)是门脉高压症引起的胃壁淤血性疾病,门静脉压升高是形成门脉高压性胃病的根本原因。     

门脉高压性胃病患者幽门螺杆菌感染率调查

目的探讨幽门螺杆菌（Hp）与肝硬化并发胃和十二指肠病变的关系。方法采用快速尿素酶试验和改良的Giemsa染色法检测Hp感染。结果在264例肝硬化患者,Hp阳性183例（69．4％）,在262例慢性胃炎（EG）患者,Hp阳性172例（66．4％,19〉0．05）;在79例肝硬化伴有PHG患者,Hp阳性60例（75．9％）,在114例肝硬化不伴PHG患者,Hp阳性75例（65．8％）,在37例肝硬化伴轻型PHG患者,Hp阳性26例（70．2％）,在42例肝硬化伴重型PHG患者,Hp阳性34例（80．9％,P〉0．05）;在56例肝硬化伴十二指肠溃疡（DU）患者,Hp阳性48例（85．7％）,在109例肝硬化不伴消化性溃疡（Pu）患者,Hp阳性67例（61．4％,P〈0．05）;在125例DU患者,Hp阳性112例（89．6％）;在28例肝硬化伴胃溃疡（GU）患者,Hp阳性20例（71．4％）,在47例GU患者,Hp阳性43例（91．5％）。结论肝硬化伴DU患者Hp感染率较高。     

门脉高压性胃病与幽门螺杆菌相关性研究

为了解门脉高压性胃病(PHG)与幽门螺杆菌(HP)的关系,采用尿素酶试验、血清HP抗体检测和14C呼吸试验等方法检测50例肝硬化PHG患者HP的感染率,并与非PHG肝硬化(NPHG)、十二指肠球部溃疡(DU)、功能性消化不良(FD)三组患者比较.PHG组HP感染率为36%,与NPHG组(38%)、FD组(44%)分别比较差异无显著性(P＞0.05),与DU组(94%)比较差异有显著性(P＜0.01).说明HP感染对PHG发病影响不大.     

肝硬化并发消化性溃疡与Helicobacter pylori感染的临床相关性研究

目的探讨Helicobacter phylori(H.pylori)与肝硬化并发消化性溃疡的临床相关性。方法 H.pylori阳性患者1 887例和H.pylori阴性患者685例,采用Logistic回归分析计算其比值比(OR)和95%CI,以此确定H.pylori感染是否是肝硬化并发消化性溃疡的独立因素。结果 100例失代偿期肝硬化合并消化性溃疡患者,H.pylori阳性38例,H.pylori阴性62例。364例代偿期肝硬化并发消化性溃疡患者,H.pylori阳性195例,H.pylori阴性169例。非肝硬化患者消化性溃疡H.pylori阳性1 654例、H.pylori阴性454例。Logistic回归分析显示,失代偿期肝硬化患者(OR=0.25,P0.001)和代偿期肝硬化患者(OR=0.52,P0.001)H.pylori感染率较低。结论 H.pylori感染可能不是肝硬化合并消化性溃疡的主要病因。     

Diagnostics of Helicobacter pylori infection in patients with peptic ulcer bleeding

BACKGROUND: In peptic ulcer bleeding, the sensitivity of H. pylori tests, in particular of the rapid urease test (RUT), has been reported to be insufficient. AIM: To validate the RUT, serology and the urea breath test were carried out in patients with bleeding peptic ulcers, and to study the influence of H. pylori suppressive treatment (HpSuT), i. e., antibiotics and proton pump inhibitors. PATIENTS AND METHODS: 123 consecutive patients (mean age 65.5 years) with a relevant bleeding from gastric or duodenal ulcers were prospectively tested for H. pylori infection by directs tests (RUT, histology, culture, urea breath test) and by IgG serology as an indirect test. Positive H. pylori status was defined by positive histology or culture. RESULTS: In patients without HpSuT during the preceding four weeks (N = 83), the sensitivity and specificity of RUT was 94 and 84 %, that of serology 83 and 68 % respectively. The sensitivity of urea breath test decreased from 82 to 60 % after even one day of HpSuT. In the overall group, the duration of HpSuT and preceding hospitalization were independent factors linked with negative results of all direct tests. CONCLUSIONS: In peptic ulcer bleeding, RUT combined with histology is an adequate diagnostic approach. However, false negative results have to be considered following even short-term HpSuT or hospitalization. Non-invasive diagnosis based on serology alone is inaccurate and should be complemented by the urea breath test prior to starting HpSuT.     

Persistence of Helicobacter pylori infection in patients with peptic ulcer perforation

Objective. In patients with perforated peptic ulcer (PPU) the convergence between the high eradication rate of Helicobacter pylori infection and low rates of ulcer relapse after treatment has been associated with reinfection by non-virulent strains. The objective of this study was to evaluate the persistence of infection by virulent H. pylori strains and ulcer recurrence in 33 patients with PPU one year after surgery and antimicrobial treatment. Material and methods. The histological evaluation and molecular detection of H. pylori cagA and ureA genes, vacA allelic types and the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analyses of the glmM gene products from antral mucosa specimens were performed initially, 2–5 months and 1 year after therapy. Results. The density of H. pylori colonization was temporarily decreased (p<0.05) 2–5 months after therapy. After one year, complete eradication was achieved in only 7 patients (23%) at histological examination and recurrent ulcers were found in 3/33 (9%) patients. The vacA s1a allelic type of cagA-positive strains persisted in 19/33 (58%) PPU patients with identical PCR-RFLP fingerprints in 8/9 (89%) of the patients. Conclusions. In PPU patients with a low eradication rate of H. pylori infection after surgical and antimicrobial treatment, the frequent recrudescence of the infection is mostly caused by the persisting virulent strains of the cagA and vacA s1a subtypes. In the 1-year follow-up period the recurrent ulceration can be postponed just by the lowered colonization density of H. pylori after eradicative therapy.     

Persistence of Helicobacter pylori infection in patients with peptic ulcer perforation

OBJECTIVE: In patients with perforated peptic ulcer (PPU) the convergence between the high eradication rate of Helicobacter pylori infection and low rates of ulcer relapse after treatment has been associated with reinfection by non-virulent strains. The objective of this study was to evaluate the persistence of infection by virulent H. pylori strains and ulcer recurrence in 33 patients with PPU one year after surgery and antimicrobial treatment. MATERIAL AND METHODS: The histological evaluation and molecular detection of H. pylori cagA and ureA genes, vacA allelic types and the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analyses of the glmM gene products from antral mucosa specimens were performed initially, 2-5 months and 1 year after therapy. RESULTS: The density of H. pylori colonization was temporarily decreased (p<0.05) 2-5 months after therapy. After one year, complete eradication was achieved in only 7 patients (23%) at histological examination and recurrent ulcers were found in 3/33 (9%) patients. The vacA s1a allelic type of cagA-positive strains persisted in 19/33 (58%) PPU patients with identical PCR-RFLP fingerprints in 8/9 (89%) of the patients. CONCLUSIONS: In PPU patients with a low eradication rate of H. pylori infection after surgical and antimicrobial treatment, the frequent recrudescence of the infection is mostly caused by the persisting virulent strains of the cagA and vacA s1a subtypes. In the 1-year follow-up period the recurrent ulceration can be postponed just by the lowered colonization density of H. pylori after eradicative therapy.     

肝硬化门脉高压性胃病与幽门螺杆菌关系的探讨

目的探讨肝硬化门脉高压性胃病(PHG)与幽门螺杆菌(Hp)感染的关系及临床意义。方法对72例PHG和50例慢性胃炎患者进行了胃镜、病理检查和Hp检测,并进行对比分析。结果伴有PHG 的肝硬化门脉高压患者的Hp感染率为23.07%,不伴有PHG者为25.0%,两者差异无显著性(P>0.05), 轻度PHG患者Hp感染率为23.80%,重度为20.0%,差异无显著性(P>0.05)。门脉高压患者的Hp感染率显著低于慢性胃炎组(23.60%比72.0%,P<0.01),但门脉高压患者慢性活动性胃炎的发生与Hp的感染密切相关,活动性胃炎的Hp感染率(53.84%)比非活动性胃炎Hp感染率(16.94%)显著升高(P< 0.01)。结论肝硬化门脉高压性胃病的Hp感染率降低,可能与肝硬化患者胃内环境不适合Hp的生存有关。门脉高压患者胃黏膜的活动性炎症,可能是由Hp感染引起,与肝硬化门脉高压关系不大。     

Characteristics of gastric cancer in peptic ulcer patients with Helicobacter pylori infection

AIM:To evaluate the incidence and clinical characteristics of gastric cancer(GC) in peptic ulcer patients with Helicobacter pylori(H.pylori) infection.METHODS:Between January 2003 and December 2013, the medical records of patients diagnosed with GC were retrospectively reviewed.Those with previous gastric ulcer(GU) and H.pylori infection were assigned to the Hp GU-GC group(n = 86) and those with previous duodenal ulcer(DU) disease and H.pylori infection were assigned to the Hp DUGC group(n = 35).The incidence rates of GC in the Hp GU-GC and Hp DU-GC groups were analyzed.Data on demographics(age, gender, peptic ulcer complications and cancer treatment), GC clinical characteristics [location, pathological diagnosis, differentiation, T stage, Lauren's classification, atrophy of surrounding mucosa and intestinal metaplasia(IM)], outcome of eradication therapy for H.pylori infection, esophagogastroduodenoscopy number and the duration until GC onset were reviewed.Univariate and multivariate analyses were performed to identify factors influencing GC development.The relative risk of GC was evaluated using a Cox proportional hazards model.RESULTS:The incidence rates of GC were 3.60%(86/2387) in the Hp GU-GC group and 1.66%(35/2098) in the Hp DU-GC group.The annual incidence was 0.41% in the Hp GU-GC group and 0.11% in the Hp DUGC group.The rates of moderate-to-severe atrophy of the surrounding mucosa and IM were higher in the Hp GU-GC group than in the Hp DU-GC group(86% vs 34.3%, respectively, and 61.6% vs 14.3%, respectively, P 0.05).In the univariate analysis, atrophy of surrounding mucosa, IM and eradication therapy for H.pylori infection were significantly associated with the development of GC(P 0.05).There was no significant difference in the prognosis of GC patients between the Hp GU-GC and Hp DU-GC groups(P = 0.347).The relative risk of GC development in the Hp GUGC group compared to that of the Hp DU-GC group,after correction for age and gender,was 1.71(95%CI:1.09-2.70;P=0.02).CONCLUSION:GU patients with H.pylori infection had higher GC incidence rates and relative risks.Atrophy of surrounding mucosa,IM and eradication therapy were associated with GC.     

Helicobacter pylori infection in peptic ulcer disease: the importance of smoking and ethnicity

This study was conducted to determine the prevalence of Helicobacter pylori (H. pylori) and its associated factors among patients with peptic ulcer disease in Taiping Hospital. Consecutive peptic ulcer disease patients who had undergone esophagogastro-duodenoscopy were included. The H. pylori status was assessed by the rapid urease test. We excluded those who had active bleeding, a perforated peptic ulcer, severe vomiting, a history of gastric surgery, peptic ulcer disease or renal or liver diseases, carcinoma of the stomach, and recent use of antibiotics or proton pump inhibitors. Socio-demography, H. pylori status, medication history and other relevant clinical data were collected from case notes. A total of 416 subjects were selected, 49.7% were positive and 50.3% were negative for H. pylori infection. There were significant associations between H. pylori and age, ethnicity, smoking status and NSAID usage. However, there were no significant relationships between H. pylori status and gender or type of peptic ulcer. Multiple logistic regression showed that other ethnicities than Malays and smokers had a higher risk of H. pylori. Our prevalence rate was low and the identified risk factors were consistent with previous studies. Ethnic differences may be related to genetic and sociocultural behaviors. Quitting smoking may benefit peptic ulcer patients with H. pylori infection.     

乙型肝炎肝硬化患者门脉高压性胃病的胃镜检查特点分析

目的探讨肝硬化门脉高压性胃病(PHG)的胃镜特点及其与肝功能分级和食道静脉曲张的关系。方法对108例乙型肝炎肝硬化患者进行常规胃镜检查,对其并发PHG情况进行回顾性分析。结果在108例患者中,发现PHG42例(38.9%),食管静脉曲张91例(84.3%);肝功能Child-Pugh分级与PHG病变程度呈正相关(r=0.385,P=0.000),食管静脉曲张程度与PHG病变程度亦呈正相关(r=0.249,P=0.009)。结论随着肝功能分级及食管静脉曲张程度的加重,PHG的严重程度也逐渐加重。     

Evaluation of Helicobacter pylori infection and other risk factors in patients with benign peptic ulcer disease

ObjectiveTo assess and compare the risk factors in patients with benign gastric and duodenal ulcers and to correlate the prevalence of Helicobacter pylori (H. pylori) infection in benign peptic ulcer disease.MethodsA total of 30 consecutive patients with peptic ulcer disease were included in this study after upper gastrointestinal endoscopy. Their clinical profile and endoscopic findings were noted. Antral biopsies were subjected to histopathological examination and urease test for detection of H. pylori. Results were correlated. The study was cleared by the Institute Research Council and the Ethics committee.ResultsThe male: female ratio was 11:4. Overall, H. pylori infection was prevalent in 93.3% of the patients. Patients who took spicy food had a significantly higher rate of H. pylori positivity (P=0.04). Smoking, alcohol intake and NSAIDs did not affect H. pylori status in patients. There was no significant association between the site of the ulcer and H. pylori infection.ConclusionsBased on our observations we conclude that prevalence of H. pylori infection is similar in duodenal and gastric ulcers and intake of spicy food is a significant risk factor.     

Six-year follow-up after successful triple therapy for Helicobacter pylori infection in patients with peptic ulcer disease.

OBJECTIVE & DESIGN: We question whether Helicobacter pylori eradication in peptic ulcer disease patients leads to a decrease in symptoms and reduced use of anti-dyspeptic drugs. Therefore, the recurrence rate of H. pylori, upper abdominal symptoms and the use of acid-suppressive drugs were determined 6 years after successful triple therapy. METHODS: Peptic ulcer disease patients successfully treated in 1990-1993 with 'classic' triple therapy were eligible. Patients were asked about symptoms and invited for a 13C-urea breath test or endoscopy in 1997-1998. Data on the use of anti-dyspeptic drugs were obtained from the pharmacy or general practitioner. RESULTS: Of the 113 eligible patients, 90 could be included in the study. The mean follow-up time was 6 years (range 4.6-7.6 years). H. pylori infection recurred in one patient (recurrence rate: 0.19% per patient-year; 95% confidence interval: 0.01-1.1%). Moderate or severe symptoms were experienced before therapy by 79% of the patients and after therapy by 18% of the patients (P< 10(-7)). Before triple therapy, 98% of the patients used H2-receptor antagonists and 54% were on maintenance treatment. After treatment, 30% used anti-dyspeptic medication and only 13% were on maintenance treatment (P < 10(-7)). CONCLUSIONS: Six years after successful triple therapy in peptic ulcer disease patients, the recurrence rate of H. pylori infection is low and both symptoms and the use of anti-dyspeptic drugs have decreased significantly.     

Epidemiology of peptic ulcer disease in cirrhotic patients: role of helicobacter pylori infection

Objective: The aim of this study was to investigate the clinical and epidemiological factors associated with the appearance of peptic ulcer in patients with cirrhosis and, in particular, the role of Helicobacter pylori infection.
Methods: A total of 201 of 220 consecutive patients included in a prospective study that aimed to evaluate the effect of dietary intervention on cirrhotic complications and survival underwent upper gastrointestinal endoscopy. At entry, an epidemiological and clinical questionnaire was completed and the presence of peptic ulcer disease or esophageal varices at endoscopy was prospectively collected. Sera were obtained and stored at −70°C until analyzed, being tested afterward for Helicobacter pylori antibodies using a commercial ELISA kit.
Results: Eleven of 201 patients had borderline anti- Helicobacter pylori IgG titers and were excluded from further analysis. In the remaining 190 patients, point prevalence of peptic ulcer was 10.5% and lifetime prevalence 24.7%. Multivariate analysis selected male sex (OR 2.3; 95%CI 1.09–4.89) and Helicobacter pylori seropositivity (OR:1.7, 95%CI 1.02–2.81) as the variables independently related to peptic ulcer disease.
Conclusions: Male sex and seropositivity for Helicobacter pylori are the major risk factors for peptic ulcer in cirrhosis.