Helicobacter pylori infection: diagnosis and treatment

Helicobacter pylori is one of the most common infections worldwide. Eradication of this important pathogen would lead to virtual elimination of the second most common cancer worldwide – gastric cancer. A variety of accurate diagnostic tests are available but current therapeutic regimens are generally unsatisfactory, with failure rates of between 20 and 40%. Difficulty in curing the infection has led to a three-step approach: diagnosis, therapy and confirmation of cure. Better studies, including head-to-head comparison of different drugs, drug formulations, dosing intervals, dosing in relation to meals, and duration of therapy are needed. The high rates of reinfection and the lack of improvements in standards of living in developing countries makes the development of a vaccine a high priority.     

Management of Helicobacter pylori infection

Helicobacter pylori is the cause of peptic ulcer, gastric cancer and gastric lymphoma. Diagnosis of H. pylori infection can be made using invasive and noninvasive tests. Invasive tests based on endoscopy, such as histology, are recommended when a gastric malignancy is suspected. Alternatively, noninvasive tests, such as the urea breath test and stool tests are useful for H. pylori diagnosis and follow-up. Triple therapy with either amoxicillin or metronidazole, clarithromycin and proton pump inhibitor given twice daily for 7–14 days is the recommended first-line treatment, after having checked the individual clarithromycin antimicrobial susceptibility. A triple therapy with levofloxacin, amoxicillin and proton pump inhibitor for 10–14 days should be used as second-line treatment, where the strains are susceptible to fluoroquinolone. Alternatively, bismuth-based quadruple therapy is recommended.     

小儿幽门螺杆菌感染与慢性胃炎

目的 :研究幽门螺杆菌 (Helicobacterpylori,Hp)感染与小儿不同类型慢性胃炎之间的关系。 方法 :对我院 2 0 0 0年—2 0 0 2年 14 0 4例具有上消化道症状 ,经胃镜检查确诊为慢性胃炎的患儿进行胃黏膜活检 ,分别行病理组织学检查及快速尿素酶试验、改良Giemsa染色找Hp ,同时患儿行血清抗HpIgG检测和 (或 ) 13 碳 尿素呼气试验 (13 C UBT)和 (或 )粪幽门螺杆菌抗原检测 (Helicobacterpyloristoolantigen ,HpSA)。 结果 :14 0 4例慢性胃炎患儿中 ,Hp感染率为 4 5 .3%。各种不同类型慢性胃炎中 ,以胃镜下结节性胃炎和消化性溃疡伴慢性胃炎的患儿Hp感染率为最高 ,分别为 71.2 %和 6 8.0 % ,明显高于其他胃炎组 (P <0 .0 1)。胃黏膜病理组织学改变 ,Hp感染组引起的黏膜炎症程度较重 ,淋巴滤泡形成比例明显较对照组高 (P <0 .0 1)。结论 :小儿时期Hp感染率已较高 ,随年龄增长Hp感染率增高。并且与小儿胃十二指肠疾病关系密切 ,其中与胃镜下结节性胃炎和消化性溃疡伴慢性胃炎最为密切。胃黏膜组织炎症程度越重 ,Hp感染阳性率越高。     

长春地区慢性胃病患者幽门螺杆菌感染状况调查

目的通过对本地区慢性胃病患者幽门螺杆菌（H.pylori）感染状况调查,了解本地区流行病学特点,为进一步阐明其与慢性胃病发生发展的关系提供理论依据。方法采用ELISA方法测定血清H.pyloriIgG抗体及CagA抗体;采取胃粘膜活检组织进行快速尿素酶试验,调查H.pylori感染情况,分析其与各种疾病的关系。结果1180例慢性胃病患者H.pylori感染率为67.11%,复合性溃疡、十二指肠溃疡、胃溃疡及慢性萎缩性胃炎感染率分别为90.9%、84.57%、83.96%和80.24%。与慢性浅表性胃炎相比差异有显著性。消化性溃疡、慢性萎缩性胃炎、胃癌和胃息肉患者血清Hp-CagA抗体的阳性率明显高于慢性浅表性胃炎（P〈0.05）。结论本地区慢性胃病患者H.pylori感染率高与多数地区的普通人群,H.pylori感染者尤其是CagA阳性者,更易发生慢性萎缩性胃炎、消化性溃疡及胃癌。     

IL-10与消化性溃疡患者幽门螺杆菌感染的关系

目的研究消化性溃疡患者幽门螺杆菌(Helicobacter pylori,Hp)感染与其血清白细胞介素10(IL-10)之间的关系。方法选取Hp阳性消化性溃疡患者114例、Hp阴性消化性溃疡患者76例,采用ELISA法分别测定其血清IL-10水平。结果消化性溃疡患者中Hp阳性组血清IL-10水平明显高于阴性组。结论Hp阳性消化性溃疡患者血清IL-10水平明显升高。     

东亚型幽门螺旋杆菌感染与胃癌发生的关系

目的 通过检测各部位慢性胃炎、胃溃疡、胃上皮内瘤变、胃癌幽门螺旋杆菌(Hp)感染情况,探讨河北省消化道肿瘤高发地区Hp感染,特别是东亚型幽门螺旋杆菌(EAS)感染与胃癌发生的关系.方法 依据国际最新悉尼系统分级标准和直观模拟评分法对慢性胃炎进行分级;分别应用Giemsa染色和免疫组织化学法检测贲门、胃体、胃窦3个部位Hp和EAS感染情况,分析Hp感染率、部位分布以及与胃癌发生的关系.结果 总体结果表明,慢性胃炎和胃溃疡中EAS阳性检出率分别为67.0%(138/206)、100.0%(12/12)明显高于上皮内瘤变43.8%(32/73)和胃癌21.7%(13/60)(P<0.05).进一步按病变部位分析贲门、胃体、胃窦和EAS阳性检出率,结果发现同一部位中慢性胃炎、胃溃疡、低级别上皮内瘤变、高级别上皮内瘤变、胃癌Hp和EAS阳性率差异无统计学意义(P>0.05).从慢性胃炎严重程度方面分析,中性粒细胞浸润程度、单核细胞浸润程度、萎缩程度、肠化生程度最严重部位均位于贲门,差异均有统计学意义(P<0.05).Hp密度最高部位位于胃体(P>0.05),但差异无统计学意义.Spearman相关性分析显示,在贲门、胃体、胃窦,Hp密度分别与中性粒细胞浸润程度、单核细胞浸润程度、萎缩程度、肠化生程度呈正相关(P均<0.05).结论 河北省消化道肿瘤高发地区ESA阳性检出率较高,其感染分别与中性粒细胞浸润深度、单核细胞浸润深度、萎缩程度、肠化生程度呈正相关,且在贲门处较易引起严重病变,贲门癌的发生与ESA感染密切相关.     

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

目的探讨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。方法采用病理组织学检查和快速尿素酶试验对76例胆汁反流性胃炎及22例兼有胆汁反流性胃炎和消化性溃疡的患者行幽门螺杆菌检测,并与29例消化性溃疡患者作对照。结果胆汁反流性胃炎组幽门螺杆菌阳性率为31.6%(24/76例),兼有胆汁反流性胃炎和消化性溃疡组幽门螺杆菌阳性率为59.0%(13/22例),消化性溃疡组幽门螺杆菌阳性率为72.4%(21/29例),前二组比较,差异有显著意义(P<0.05),后二组比较,差异无显著意义(P>0.05)。结论胆汁反流在胆汁反流性胃炎的发病中起主要作用,幽门螺杆菌感染在消化性溃疡的发病中起主要作用。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的共同发病中互不明显影响,幽门螺杆菌感染所起的作用可能更大一些。     

慢性胃炎与消化性溃疡患者幽门螺杆菌的感染状况及诊断方法

本文通过200例患者活检标本的对比研究证明,幽门螺杆菌在消化性溃疡与活动期慢性胃炎中有较高的感染率,分别为68%～92%和62.9%～92.6%;而非活动期慢性胃炎仅为36.6%～39.8%.同时证明,用pH试纸检测尿素酶的存在是一个经济、简易、快速、有较高特异性和敏感性的诊断幽门螺杆菌感染的方法.     

New Options in Eradication of Helicobacter pylori

Better treatment options to eradicate Helicobacter pylori are needed, while we await a possible effective vaccine against the world's most common infection. The goals of therapy for H. pylori infection should be an effective and low-cost therapy with a low frequency of side-effects. The currently available eradication regimens are cumbersome, which can lead to a reduction of compliance and a lower efficacy. More recent studies have shown, however, that the duration of antimicrobial treatment may be shortened, which also makes the treatment more cost-effective and more tolerable. At this point it seems relevant to treat H. pylori infection first with some antisecretory modification of triple therapy, while the therapeutic failures can be treated with other more relevant and suitable alternatives. Metronidazole is still a cornerstone of triple therapy and the more expensive clarithromycin is an alternative second-line treatment. Time will show the effectiveness and suitability of the latest topical 1-day treatments.     

胃十二指肠疾病与幽门螺杆菌感染关系的研究

目的 :探讨胃十二指肠疾病与幽门螺杆菌感染的关系。方法 :对 5 73例患有不同胃十二指肠疾病的患者施行胃镜检查及胃粘膜碱性粉红试验。结果 :5 73例胃十二指肠不同疾病幽门螺杆菌检出率各异 ,其中消化性溃疡阳性率高。结论 :Hp是慢性胃炎、尤其是慢性活动性胃炎、消化性溃疡的重要致病原因之一 ,还可能是胃癌的协同致癌原     

Immunohistochemical differences in gastric mucosal damage between nodular and non-nodular gastritis caused by Helicobacter pylori infection

In this study, the level of cell damage were analyzed immuno­histochemically to clarify the association between nodular gastritis and undifferentiated gastric cancer. Thirty patients of nodular gastritis were enrolled as the nodular gastritis group. Thirty patients of non-nodular gastritis were enrolled as the control group. They were evaluated according to the updated Sydney system and used for immunohistochemical staining (p53, Ki-67, E-cadherin, and 8-OHdG). The scores based on the updated Sydney system were significantly higher in the nodular group than in the non-nodular group for histologically assessed inflammation and activity in the gastric corpus (1.91 ± 0.77 vs 1.58 ± 0.60, p = 0.049, 0.83 ± 0.81 vs 0.44 ± 0.64, p = 0.032). On immunostaining, the detection of E-cadherin was lower in the nodular group for both the antrum (1.0 ± 0.62 vs 1.47 ± 0.85, p = 0.047) and the corpus (1.16 ± 0.81 vs 1.48 ± 0.71, p = 0.043) and the p53 labeling index of the gastric corpus was higher in the nodular group than in the non-nodular group (3.06 ± 1.94 vs 2.03 ± 1.99, p = 0.015). Nodular gastritis showed significant severe inflammation and immunohistochemical cell damage compared with non-nodular gastritis. These findings may play an important role in the oncogenesis of undifferentiated gastric cancer in nodular gastritis.     

Inverse time trends of peptic ulcer and reflux esophagitis show significant association with reduced prevalence of Helicobacter pylori infection

Abstract

Introduction

Recent prevalence and trends of gastric/duodenal ulcer (GU/DU) and reflux esophagitis (RE) are inadequate.     

自然杀伤T细胞在幽门螺旋杆菌阳性消化性溃疡患者中的水平与临床意义

目的探讨幽门螺旋杆菌(Hp)阳性消化性溃疡患者(PU)外周血自然杀伤T细胞(NKT)的表达与临床意义。方法选择83例Hp阳性PU患者(A组),以79例Hp阴性PU患者作为阳性对照(B组),以60例健康人作为阴性对照(C组);采用流式细胞术检测A、B及C三组外周血NKT及其胞内细胞因子γ-干扰素(IFN-γ)及白介素4(IL-4)水平。将A组患者随机分为D及E组,两组均给予雷贝拉唑及甲硝唑治疗,D组在此基础上给予克拉霉素治疗,E组给予阿莫西林治疗,两周后进行NKT、IFN-γ及IL-4的水平比较,并将3种指标与治疗前Hp感染的程度进行相关性分析。结果 B与C组间的NKT及IFN-γ差异均无统计学意义,但A组NKT及IFN-γ水平低于B及C组,差异有统计学意义(P0.05)。A组IL-4低于B组,且B组低于C组,差异有统计学意义(P0.05)。治疗前D及E组间的NKT、IFN-γ及IL-4差异均无统计学意义(P0.05),治疗后D组3种指标均显著高于E组(P0.05)。Spearman分析显示NKT、IFN-γ及IL-4均与Hp感染程度呈负相关。结论 NKT、IFN-γ及IL-4水平下降导致杀伤力降低可能原因为Hp感染致PU的免疫机制破坏,且感染越重三者水平越低;克拉霉素在上调NKT、IFN-γ及IL-4的表达效果优于阿莫西林。     

胆汁反流、胃酸、幽门螺杆菌感染对胃黏膜损伤的影响

目的　探讨胆汁反流、胃酸、幽门螺杆菌 (Hp)感染对胃黏膜损伤的影响。方法　 30例具有胆汁反流症状并经胃镜检查证实有胆汁反流的患者 ,同步行动态 2 4小时胃内胆汁及 pH值监测 ,胃镜下取胃窦胃小弯处黏膜 4块 ,1块做快速尿素酶试验 ,3块做病理检查 ;常规固定、包埋、切片和苏木精和伊红 (HE)、Giemsa染色 ,后者用于Hp检测 ;根据胃窦黏膜有无活动性炎症、萎缩、肠化和不典型增生分别记 2分或 1分 ;根据上腹痛、腹胀、吐苦水、恶心、嗳气和食欲不振的程度给予症状评分 ;得出胆红素吸收值 (Abs)≥ 0 .14的时间百分比、pH值 <4的时间百分比 ,以及胃内Abs与pH值对应表。结果　 30例患者中Hp的感染率是 2 3.3% ,胃内Abs≥ 0 .14的时间百分比是 (30 .6 4±14 .6 7) % ;胃内Abs≥ 0 .14的时间百分比Hp阳性组 (2 0 .6 4± 7.13) % ,Hp阴性组 (4 0 .38± 13.35 ) % ,两者相比差异有统计学意义 (P <0 .0 5 ) ;胃窦部黏膜糜烂、肠化的程度积分与胆汁反流程度呈正相关 (r =0 .74 9,P =0 .0 0 5 )。结论　胆汁反流可以抑制Hp在胃内的定植 ,胆汁反流是胃黏膜损伤的危险因素     

Time trends in the prevalence of Helicobacter pylori infection in patients with peptic ulcer disease: a single-center retrospective study in Shanghai

ObjectiveThe present study aimed to investigate the recent trends in Helicobacter pylori infection associated with peptic ulcer disease in a large population in Shanghai.MethodsWe analyzed the medical records of all patients who had undergone upper gastrointestinal endoscopy (EGD) for uninvestigated dyspepsia at Ren Ji Hospital between 2013 and 2019 to determine the prevalence of H. pylori infection in patients with peptic ulcers.ResultsPeptic ulcers were found in 40,385 of the 383,413 patients who underwent EGD during the study period. Over the 7-year study period, the annual prevalence of H. pylori among patients receiving EGD declined from 32.2% to 26.5%. H. pylori was present in 60% of ulcers and the incidence was higher (66.9%) in duodenal compared with gastric ulcers (48.5%). The proportion of H. pylori-associated gastric ulcers declined from 52.2% to 49.3% and that of H. pylori-positive duodenal ulcers declined from 70.0% to 63.9%.ConclusionThe prevalence of H. pylori-positive peptic ulcers, mainly duodenal ulcers, fell from 2013 to 2019. However, the proportion of non-H. pylori-associated peptic ulcer disease increased, especially in elderly people, possibly due to the use of nonsteroidal anti-inflammatory drugs. Further research is needed to confirm this hypothesis.     

慢性胃炎患儿家族内幽门螺杆菌亚型感染分析

目的了解慢性胃炎患儿家族幽门螺杆菌（Hp）感染的情况以及家族内幽门螺杆菌亚型的分布。方法采集14例因反复腹痛来我院就诊的患儿及其家庭成员共73例的静脉血,应用幽门螺杆菌金标免疫斑点法和免疫印迹法对患儿及其家族成员进行Hp抗体和亚型的检测。结果慢性胃炎患儿家族中Hp抗体阳性率i00％,免疫印迹Hp亚型抗体阳性率95．9％,其中I型Hp感染占60．3％,Ⅱ型Hp感染占35．6％。I型HP及Ⅱ型Hp感染阳性率在患几与二级亲属之间差异均有统计学意义（P〈0．05）,VacA抗体检出率在有胃肠道疾病组（66．7％）及无胃肠道症状组（35．3％）之间差畀有统计学意义（P〈O．05）。家族成员患Hp感染胃肠道疾病有家庭聚集现象。结论慢性胃炎患儿家族中Hp感染阳性率高,I型Hp感染阳性率随年龄的增加而升高,Ⅱ型Hp感染阳性率随年龄的增加而降低,VacA抗体的分布与消化道症状有关。     

幽门螺杆菌L 型感染对胃癌侵袭和转移能力的影响

目的：探讨幽门螺杆菌L型（H p‐L型）感染对胃癌侵袭和转移能力的影响。方法选取胃癌患者80例,每例患者采集癌组织及癌旁正常组织各1份,制作切片标本,采用革兰染色、免疫组化染色、透射电镜对组织标本进行 Hp‐L型、基质金属蛋白酶‐9（MMP‐9）、血管内皮生长因子（VEGF）检测。结果癌组织标本 Hp‐L 型阳性率为67．50％,高于癌旁正常组织的23．75％（P＜0．05）。癌组织标本MMP‐9、VEGF阳性率均高于癌旁正常组织（P＜0．05）。 Hp‐L型阳性癌组织VEGF、MMP‐9阳性率均高于 Hp‐L型阴性癌组织（P＜0．05）。胃癌组织Hp‐L型阳性率与癌细胞局部和远处淋巴结转移及侵袭深度相关,与肿瘤大小无关。结论 Hp‐L型感染与胃癌的发生密切相关,也有可能对胃癌转移和侵袭产生影响。     

淄博地区铁路系统幽门螺杆菌感染的调查分析报告

目的探讨幽门螺杆茼感染的途径以及与年龄、性别、职业等的关系。方法采用胶体金法检测被调查者的血清（血浆）内幽门螺杆菌尿素酶的含量;并把被调查者分为三组：年龄组、性别组、职业组。结果健康体格检人群是幽门螺杆菌感染与年龄无显著相关性,与性别、职业有显著相关性。结论正常人群通过体检方式检测出幽门螺杆菌抗体阳性者为感染人群或既往感染者,讨论其感染原因以及与职业、年龄、性别的相关性;与胃癌、胃外其他疾病的联系;给出合理的预防建议。避免感染或再感染。     

胆汁反流性胃炎与幽门螺杆菌的关系

目的 探讨幽门螺杆菌（Hp）感染与胆汁反流性胃炎的关系。方法 采用病理组织学检查和快速尿素酶试验对胃镜和病理组织学诊断明确的104例胆汁反流性胃炎及148例慢性胃炎的患者行Hp检测，比较两组患者Hp检出阳性率。结果 胆汁反流性胃炎组Hp阳性率为22．1％，慢性胃炎组Hp阳性率为43．9％。两组比较差异有显著性意义（P〈0.01）。结论 胆汁反流性胃炎的患者，反流的胆汁可能有抑制和杀灭Hp的作用。