老年人消化性溃疡166例胃镜分析

目的了解我院老年人消化性溃疡（Pu）发病特点。方法分析166例老年人消化性溃疡胃镜报告结果。结果老年人PU的检出率为10.78％,男女之比为4.35：1;胃溃疡（GU）占62.65％,十二指肠溃疡（DU）占30.72％,GU与Du之比为2.08：1,复合性溃疡占6.62％,多发性溃疡占24.1％。结论老年人PU的患者男性多于女性,Gu多于DU,GU的好发部位是胃窦和胃角,DU的好发部位是十二指肠球前壁;PU的幽门螺杆菌（Hp）感染率为81.93％。     

三联疗法对幽门螺杆菌感染者胃上皮细胞的影响

目的：观察“三联疗法”对（幽门螺杆菌）感染者胃黏膜上皮细胞凋亡与一氧化氮（NO）的影响。方法；分别用TUNEL法和NADPH—d法对HP阳性的十二指肠球部溃疡（DU）、胃溃疡（GU）治疗前后以及组织学上正常的HP阴性者各10例的胃黏膜活检组织进行细胞凋亡和一氧化氮检测。结果：在HP阳性的十二指肠溃疡、胃溃疡、HP阴性的正常组织中，细胞凋亡逐渐减少，凋亡指数除在胃溃疡与球部溃疡之间差异无显著性外（P〉0．05），两组与正常组相互比较差异均有显著性（P〈0．05）。“三联疗法”后，HP转阴，细胞凋亡显著减少，NOS阳性细胞数在HP阳性的实验组比HP阴性的正常对照组显著增多（P〈0．01），但各实验组之间差异均无显著性（P〉0．05）。在HP阳性的十二指肠溃疡、胃溃疡细胞凋亡与NOS呈显著正相关（P〈0．05）。结论：HP感染能诱导胃上皮细胞凋亡，引起胃黏膜NO的升高。“三联疗法”可使HP转阴，并通过抑制胃黏膜上皮细胞凋亡与NO的产生而达到治疗作用。     

老年人消化性溃疡与慢性萎缩性胃炎的相关性研究

目的研究老年人消化性溃疡与慢性萎缩性胃炎的相关性。方法对十二指肠溃疡（DU）、胃溃疡（GU）和复合性溃疡（CU）的老年患者胃窦、胃窦胃体交界处和胃体黏膜以及慢性胃炎（CG）患者胃窦黏膜活检标本进行组织学检查,统计各自胃黏膜的萎缩、肠化生、慢性炎症、活动性和幽门螺杆菌（Hp）感染的发生率。结果 DU患者胃窦、胃窦胃体交界处和胃体黏膜的萎缩发生率分别为54.0%、8.0%和16.0%,肠化生发生率分别为19.0%、6.0%和4.0%。其胃窦黏膜肠化生的发生率明显低于相应的GU、CU或CG者。3种消化性溃疡和CG患者均存在胃窦部慢性炎症,且老年消化性溃疡患者胃体部炎症的发生率较高,其胃炎活动性以胃窦部为主,且均较CG者高。结论老年人消化性溃疡均可有胃窦部灶性萎缩和肠化生发生,但DU胃窦黏膜肠化发生率最低,这可能是老年DU患者罹患胃癌危险性较低的原因之一。     

Gastric emptying in patients with gastric and duodenal ulcer

Gastric emptying was measured in patients with proximal gastric, distal gastric and duodenal ulcers using a radioisotopic method. Gastric emptying was rapid in patients with proximal gastric ulcer, and was considered to be due to accelerated proximal evacuation. However, emptying was delayed in patients with distal gastric ulcer, and was considered to be due to reduced emptying in the antrum. On the other hand, rapid emptying seen in duodenal ulcer patients was considered to be due to accelerated emptying in both the proximal stomach and the antrum. Gastric emptying in the healing stage was closer to that in healthy subjects than in patients with active-stage ulcer.     

胃肠相关疾病中幽门螺杆菌感染与胃黏膜白细胞介素-8含量的关系

目的　研究各种胃肠疾病幽门螺杆菌 (Hp)感染情况及其与胃黏膜白细胞介素 8(IL 8)含量的关系。 方法　采用双抗体夹心酶联免疫吸附试验检测 10 2例Hp感染与非感染患者胃黏膜匀浆上清液中的白细胞介素 8含量 ,其中胃镜下黏膜正常者 5例 ,单纯性慢性胃炎 (CG) 2 5例 ,十二指肠球部溃疡 (DU) 36例 ,胃溃疡 (GU) 15例 ,胃癌(Gca) 2 1例。结果　 10 2例中有 6 0例感染了Hp(5 8.8% ) ,其中以十二指肠球部溃疡组Hp感染率最高 (88.9% ) ,明显高于其他组 (均P <0 .0 5 ) ,Hp感染者胃黏膜IL 8含量明显高于非Hp感染者 (P <0 .0 1) ;GU、Gca、DU、CG组胃黏膜IL 8含量均明显高于黏膜正常组 (均P <0 .0 5 ) ,GU、Gca、DU组又明显高于CG组 (均P <0 .0 5 ) ,而GU、Gca、DU组间比较差异无统计学意义 (均P >0 .0 5 ) ;同时发现中度胃炎黏膜IL 8含量明显高于轻度胃炎 ,活动性胃炎又明显高于非活动性胃炎 (均P <0 .0 5 )。结论　Hp感染者与非感染者胃黏膜IL 8含量存在差异 ,疾病组胃黏膜IL 8含量明显高于正常黏膜 ,并与胃炎炎症程度和活动性有一定相关性 ,推测IL 8可能参与了Hp相关性胃炎胃黏膜损伤机制     

幽门螺杆菌多部位检测与临床及组织学表现的关系

目的 观察幽门螺杆菌（Hp）与胃及十二指肠粘膜病理组织学表现之间的关系。方法 对60例慢性胃炎和22例十二指肠溃疡患者经胃镜分别从胃窦、胃体、十二肠球部取活检,进行组织学检测。结果 在活动性胃炎中无论是胃窦部或胃体部Hp检出率近100％,显著地活动性十二指肠球炎的球部Hp的检出率,胃窦部Hp总检出率及活动性上的发生率均显著高于胃体部及十二指肠球部。22例十二指肠球部溃疡Hp在球部的检出率为54％,显著低于其在胃窦部组织中Hp100％的检出率。结论 Hp感染是胃粘膜活动性炎症的重要原因,并以此为基础发展为重度粘膜炎及溃疡病,因此,对某些慢性胃炎患者应及早进行Hp根除治疗。     

Colloid bismuth versus famotidine in the treatment and prevention of duodenal ulcer relapse: results of a double-blind, double dummy randomized study

Summary— Fifty-three consecutive patients with active duodenal ulcer (DU) were randomly included in a double-blind, double-dummy study to test the healing and relapsing rate of two treatment regimens: famotidine 40 mg nocte for 4–8 weeks, followed by 20 mg for 12 months after healing of the ulcer and colloidal bismuth (CBS) (240 mg bid) for 4–8 weeks, followed by placebo maintenance treatment. The results of the short term period confirmed the efficacy of CBS in healing DU (24/25 in CBS group and 19/23 in famotidine group). However, the relapse rate in the CBS-treated group was higher (77.8% at 12 months) than in the famotidine group (35.7%) ( p = 0.041). Only 7 patients (41.2%) were cleared from Helicobacter pylori (HP) after CBS treatment. In conclusion, the high relapse rate observed in CBS treated patients may be related to the high percentage of patients with HP infection in the tested group and support the hypothesis that lack of efficacy of CBS in preventing DU recurrence is related to its poor eradication of HP.     

Strategies for peptic ulcer healing after 1 week proton pump inhibitor-based triple Helicobacter pylori eradication therapy in Japanese patients: differences of gastric ulcers and duodenal ulcers

Helicobacter pylori (H. pylori) eradication therapy alone is insufficient to ensure healing of large ulcers with H. pylori-positive gastric ulcer (GU). The question of what is the optimum antiulcer treatment following H. pylori eradication therapy has not been fully elucidated. Furthermore, the ulcer healing effects of eradication therapy itself with H. pylori-positive duodenal ulcer (DU) have not been investigated. In GU study, the eradication therapy + proton pump inhibitor (PPI) group (group A) were administered eradication therapy followed by 7 weeks of a PPI, and the eradication therapy + gastroprotective drug (GP) group (group B) eradication therapy followed by 7 weeks of a GP. In DU study, the eradication therapy + PPI group (group C) were administered eradication therapy followed by 5 weeks of a PPI, and the eradication therapy only group (group D) was eradication therapy alone. In GU study, healing rates for ulcer of ≥15 mm in diameter were significant greater in the group A. In DU study, high healing rates were seen both the group C and D. In conclusion, a PPI could significantly heal GU than a GP after eradication therapy in GU. Meanwhile, the eradication alone is sufficient for DU.     

Reactions of humoral and cellular immunity in peptic ulcer in relation to the condition of the gastric mucosa

A total of 160 persons including 50 patients with duodenal ulcer (DU) and 38 with gastric ulcer (GU) were examined for antibodies to the parietal cells of the stomach (PCA) and cell cellular immunity responses to autologous antigen from the gastric mucosa. It was shown that both PCA of the stomach and cell immunity responses in patients with GU and DU occurred in an insignificant number of cases. No differences were revealed in the humoral and cellular immunity in GU and DU persons with and without concomitant gastritis or in the stage of exacerbation and ulcer cicatrization.     

Molecular forms of gastrin in peptic ulcer: comparison of serum and tissue concentrations of G17 and G34 in gastric and duodenal ulcer subjects

We have studied the relationships between the main molecular forms of gastrin (G17 and G34) in the serum, antral and duodenal mucosa of duodenal (DU) and gastric (GU) ulcer patients. Fasting serum G17 was similar in both DU and GU (about 6 pmol/l) and in both groups increased about three-fold with feeding. In contrast, basal serum G34 was significantly higher in GU (29 pmol/l) than in DU (12 pmol/l) and the peak post prandial increase over basal of G34 was also higher in GU (57 pmol/l) compared with DU (10 pmol/l). In sharp contrast, in the same groups of DU and GU patients mean total antral gastrin concentrations were similar (about 12 nmol/g), and in both groups 95% of antral gastrin was G17, most of the remainder being G34. In both groups total duodenal gastrin concentrations were about 20% those in antral mucosa and about 70% of duodenal gastrin was attributable to G34. The higher serum G34 in GU could therefore be explained by increased secretion of duodenal gastrin, but further work is needed to examine whether there might also be preferential secretion of antral G34 in GU, or a difference in the metabolism (or volume of distribution) of gastrin variants in GU and DU.     

Comparison of the effectiveness of tri- and quadricomponent eradication therapy in patients with peptic ulcer

The purpose of the study was to compare the effectiveness of tri- and quadri-component therapy of Helicobacter pylori (HP)-associated peptic ulcer (PU). The subjects were 65 patients with duodenal ulcer (DU), divided into two groups. The first, OKM/A group, included 35 patients receiving omeprazole in a dose of 20 mg twice a day, clarythromycin--500 mg twice a day, and metronidazole--500 mg or amoxicillin--1,000 mg twice a day. The second, OBTM group, included 30 patients receiving omeprazole in a dose of 20 mg twice a day, colloid bismuth subcitrate (de-nol)--120 mg four times a day, tetracycline--500 mg four times a day, and metronidazole--500 mg twice or 250 mg four times a day. The study demonstrated high effectiveness of these regimens in HP eradication, time of coping with pain syndrome, and time of ulcer healing. Although the difference between the results in the groups was insignificant, there were certain trends observed. On the one hand, the regimen including clarythromycin seemed to be more effective vs. the regimen including tetracycline. On the other hand, the cost of the clarythromycin regimen is about 1.8 times higher than the tetracycline regimen, due to high cost of clarythromycin. The study shows that quadri-therapy in patients with a DU relapse allows maintenance of the intragastric acidity at the level which is optimal for quick coping with pain and dyspeptic syndromes, lowering of the degree of inflammatory alterations in the gastric and duodenal mucosa, HP eradication, and ulcer healing.     

泮托拉唑对幽门螺杆菌相关性十二指肠溃疡的疗效观察

目的观察泮托拉唑治疗幽门螺杆菌(Hp)相关性十二指肠溃疡的临床疗效。方法48例Hp阳性感染的十二指肠溃疡患者随机接受泮托拉唑联合羟氨苄青霉素和克拉霉素治疗或仅服用雷尼替丁治疗。4周后观察临床症状情况,并经胃镜检查观察溃疡愈合和Hp清除。结果经4周治疗发现,泮托拉唑治疗组患者明显改善临床症状(如反酸、烧心、上腹部疼痛等)并使溃疡愈合。胃窦部炎症分级明显降低,Hp也得到有效清除(P<0.05)。结论泮托拉唑联合抗Hp治疗可有效地控制十二指肠溃疡的临床症状,加速溃疡愈合,清除Hp的感染,是治疗十二指肠溃疡的一种有效、价廉的方法。     

The morphofunctional characteristics of the duodenal mucosa in patients with a duodenal ulcer at different phases of the disease

Endoscopic, morphological, histochemical and biophysical properties of the duodenal mucosa as well as secretory activity of the stomach and pancreas were studied and compared in 398 patients with duodenal ulcer in different phases (active ulcer, healing ulcer, red and white scars). Sixteen patients were observed over time. Analogous studies were conducted in 88 patients with chronic diseases of the biliary and duodenopancreatic zone (with non-ulcerous duodenitis) and in 32 normal persons. The duodenal mucosa was established to undergo consistent morphofunctional reorganization related to the disease phase. Active duodenal ulcer was marked by duodenitis with thickening of the mucosa, shortening of the villi, reduction of the depth of the cryptae, gastric metaplasia, impairment of histochemical properties of epitheliocytes and decrease of the transmural potential difference, overproduction of acid and pepsin in the basal period, high sensitivity of the chief cells to stimulation, and insufficient output of bicarbonates by the pancreas. Gastric metaplasia of the duodenal epithelium, appreciable histochemical and morphometric alterations may be regarded as relatively specific traits of peptic duodenitis. As ulcer heals, a well-defined tendency may be noted towards normalization of all the parameters mentioned. However, they only correspond to normal in 25% of patients in the phase of a white scar. The conclusion is made that there is also a necessity of correcting morphofunctional abnormalities after duodenal ulcer healing.     

Molecular forms of gastrin in peptic ulcer: comparison of serum and tissue concentrations of G17 and G34 in gastric and duodenal ulcer subjects

Abstract We have studied the relationships between the main molecular forms of gastrin (G17 and G34) in the serum, antral and duodenal mucosa of duodenal (DU) and gastric (GU) ulcer patients. Fasting serum G17 was similar in both DU and GU (about 6 pmol/1) and in both groups increased about three-fold with feeding. In contrast, basal serum G34 was significantly higher in GU (29 pmol/1) than in DU (12 pmol/1) and the peak post prandial increase over basal of G34 was also higher in GU (57 pmol/1) compared with DU (10 pmol/1). In sharp contrast, in the same groups of DU and GU patients mean total antral gastrin concentrations were similar (about 12 nmol/g), and in both groups 95% of antral gastrin was G17, most of the remainder being G34. In both groups total duodenal gastrin concentrations were about 20% those in antral mucosa and about 70% of duodenal gastrin was attributable to G34. The higher serum G34 in GU could therefore be explained by increased secretion of duodenal gastrin, but further work is needed to examine whether there might also be preferential secretion of antral G34 in GU, or a difference in the metabolism (or volume of distribution) of gastrin variants in GU and DU.     

Proton pump inhibitor for maintenance therapy of peptic ulcer]

The strategy for peptic ulcer therapy has been changing with the clinical application of the gastric proton pump inhibitor (PPI). In Japan, Miyoshi et al and Takemoto et al reported an earlier reepithelialization of peptic ulcer with omeprazole (OME) or lansoprazole (LAN) than famotidine (FAM). Miyoshi et al also reported that there was no significant difference between OME and FAM in ulcer relapse rate during a one year follow-up period. Therefore, there were two problems. One is application of PPI for prevention of ulcer relapse, and the other is the more accurate diagnosis of ulcer healing. Application of PPI for maintenance therapy is not yet realized in Japan, but, Lauritsen et al had already reported on the efficacy and safety of OME, 20 mg, three days a week and 10 mg, daily in prevention of duodenal ulcer relapse. Reepithelialization (red scar) is already established as a starting point of maintenance therapy, and from Miyake's report, a white scar is believed a favorable (non relapsing) end point.     

幽门螺杆菌感染与十二指肠胃上皮化生及胃泌素之间关系的研究

目的　通过对幽门螺杆菌 (Hp)感染与十二指肠胃上皮化生 (DGM )及胃泌素 (GAS)关系的研究 ,探讨Hp导致十二指肠溃疡 (DU)的发病机制。 方法　检测了 12 1例患者内镜、病理、Hp感染及DGM情况。同时测定了其中 6 6例患者的血清GAS浓度。结果　球部有溃疡者 ,胃及球部Hp检出率均显著高于球部无溃疡者 (P <0 .0 0 1) ;但球部Hp检出率在DU与CU、GU与CG之间无差别 (P >0 .0 5 ) ;球部有溃疡者DGM的检出率显著高于球部无溃疡者 (P <0 .0 0 1) ,且前者的DGM程度更重 (P <0 .0 0 1) ,但在DU与CU、GU与CG之间无差别 (P >0 .0 5 ) ;胃部Hp阳性者DGM的发生率 (73.0 % )显著高于胃部Hp阴性者 (37.5 % ,P <0 .0 0 1) ,DGM( )及以上者在Hp阳性组发生率 (47.2 % )也高于Hp阴性组 (2 1.9% ,P <0 .0 5 ) ;Hp阳性者血清GAS浓度显著高于Hp阴性者 (P <0 .0 1) ,但血清GAS浓度在Hp阳性的DU、CU、GU与CG之间无差别(P >0 .0 5 ) ;有DGM者血清GAS浓度也显著高于无DGM者 (P <0 .0 1) ,且随着DGM程度的加重 ,血清GAS浓度早递增趋势 ,两者呈正相关 (rs=0 .4 2 ,P <0 .0 1)。结论　Hp感染特别是十二指肠Hp定植及DGM是影响DU发生、发展的两大危险因素。Hp可影响DGM的发生与发展 ,其中部分可能通过增加血清GAS分泌的作用。     

Serum IL-8 as a possible marker for determining the status of<Emphasis Type="Italic">Helicobacter pylori</Emphasis> infection in patients with untreated and treated peptic ulcer

Failure to eradicateHelicobacter pylori can lead to peptic ulcer recurrence and gastric malignancy. Therefore, the objective of this study was to develop a noninvasive method for determining whetherH pylori infection was eradicated with antibiotic-based triple therapy. A total of 17 patients with duodenal ulcer (DU) and 17 with gastric ulcer (GU) were evaluated both before and after treatment. Outcomes included serum levels of interleukin-8 (IL-8), pepsinogen I, and gastrin, and the Wilcoxon signed rank test was used to test significance. Changes in these parameters were also correlated with disease status. In those patients where both GU and DU healing occurred as a result of treatment, most showed an increase in serum IL-8 and a decrease in serum pepsinogen. Serum gastrin levels were not significantly changed in either group. Posttreatment increases in serum IL-8 were seen in 15 of 17 (88%) recovered DU patients and 14 of 17 (82%) recovered GU patients (P < .05 for each). Posttreatment decreases in pepsinogen I were found in 15 of 17 DU and 15 of 17 GU patients (P < .05 for each). These preliminary findings suggest that an increase in serum IL-8 and possibly a decrease in pepsinogen I may be useful in identifying the successful eradication ofH pylori infection in patients with peptic ulcer treated with antibiotics. A more systematic analysis of these putative diagnostic markers is now warranted.     

Quantitative-qualitative assessment of duodenogastric reflux at 24-h pH-metry

AIM: To study characteristics (other than duration) of duodenogastric reflux (DGR), correlations of secretory function and DGR characteristics with gastroduodenal disorders (ulcer, chronic hyperacid gastritis). MATERIAL AND METHODS: A total of 110 patients were examined with 24-h pH-metry: 68 patients with duodenal ulcer (DU), 15 patients with gastric ulcer (GU), 27 patients with chronic hyperacid gastritis (CHG). Mean levels of pH and duration of hyperacidity in the body and an antral part of the stomach, duration of DGR, pH in the body and antral part of the stomach depending on DGR severity were studied. RESULTS: DGR was registered almost in all the patients with DU, GU and CHG. Groups of the patients differed by duration and height" of the DGR. CONCLUSION: Patients with DU are characterized by low refluxes which do not reach gastric body.     

Relationship between duodenal ulcer recurrence rate and the degree of gastric mucosa contamination rate with Helicobacter pylori

Recurrence rate of duodenal ulcer (DU) within one and two years after treatment was studied in 42 DU patients with incomplete eradication of Helicobacter pylori (HP) and 16 DU patients with its complete eradication. It is shown that DU recurrence rate after the treatment depends on the degree of gastric mucosa contamination with HP. The risk of the DU recurrence is much higher in moderate and high contamination with HP.