Duodenogastric reflux after choledochoduodenostomy

Duodenogastric reflux (DGR) has been implicated in several disease processes. The present study was carried out to document the incidence and evaluate the clinical significance of DGR after choledochoduodenostomy (CDD). A total of 13 patients who had undergone cholecystectomy with a standard side-to-side CDD for choledocholithiasis or chronic pancreatitis were studied by symptom evaluation, scintigraphy, endoscopy, and gastric mucosal histology at least 6 months after surgery. The scintigraphic findings were then compared with those of 10 patients who had undergone cholecystectomy alone. Only two patients (15%) had mild dyspeptic symptoms. The incidence of DGR after CDD was 69% compared to 20% in the cholecystectomy alone group (P < 0.05). In the majority of patients the DGR was only mild to moderate and the severity correlated well with the degree of endoscopic gastritis, but not with the clinical symptoms or histological findings. These results indicate that while CDD is associated with a high incidence of DGR, its occurrence does not produce significant clinical symptoms.     

糜烂性胃炎462例分析

目的探讨糜烂性胃炎(EG)在内镜下的形态、分布及预后.方法对1997年1月～2003年12月经内镜确诊的462例糜烂性胃炎进行分析.结果462例中,男性336例,女性126例,男女之比2.67:1.隆起糜烂型185例,占40.04%;平坦糜烂型277例,占59.96%.胃窦部363例,占总数的78.57%;其中隆起糜烂型173例,占47.66%;平坦糜烂型190例,占52.34%,两型之间差异无显著性(P＞0.05).胃高位99例,占总数的21.43%;其中隆起糜烂型12例,占12.12%;平坦糜烂型87例,占87.88%;胃窦部隆起糜烂型占47.66%(173/363),胃高位隆起糜烂型占12.12%(12/99);隆起糜烂型和平坦糜烂型HP感染率分别为83.78%和27.08%,差异有非常显著性(χ2=142.68,P＜0.01).结论胃窦部与胃高位糜烂性胃炎的发病率均以男性为主,其中隆起糜烂型好发于胃窦部,而胃高位以平坦糜烂型为主.     

Helicobacter pylori infection and gastric emptying of solids in humans

Helicobacter pylori has been implicated in a number of upper gastrointestinal illnesses. In a controlled study, we have investigated the relationship between H. pylori infection and gastric emptying of solids in two groups of patients with chronic symptoms of dyspepsia. In the first group, 19 patients with non-ulcer dyspepsia and H. pylori infection underwent a standard test of gastric emptying after ingestion of 500 μCi of Tc-labelled chicken liver. The results were compared to a control group of 16 uninfected volunteers. We also studied a second group of 20 patients with previously diagnosed idiopathic gastroparesis for the prevalence of H. pylori infection and its relationship to symptom severity and rates of gastric emptying. In the first group of patients, the half-time of gastric emptying was significantly less among the infected patients compared to the uninfected volunteers (108 ± 9 vs. 142 ± 14 min, P < 0.05). In the second group of patients with gastroparesis, the prevalence of H. pylori was not significantly different among these patients than among 21 age and sex matched controls (20% vs. 38%, P = 0.32). Gastric emptying was markedly slow in all 20 patients in the second group but less so among the four with H. pylori infection. Symptom scores were no different between infected and uninfected patients. We conclude that H. pylori infection is not associated with abnormally slow gastric emptying. On the contrary, gastric H. pylori infection appears to be associated with mildly accelerated emptying of solids compared to normal controls. Idiopathic gastroparesis and dyspepsia related H. pylori infection are separate but sometimes overlapping disorders.     

氟中毒和氟砷中毒对胃粘膜的影响

作者通过内窥镜对新疆奎屯地区氟中毒患者３５名，氟砷中毒患者３２名，对照组２５名的胃粘膜进行观察，旨在了解氟元素和砷元素对胃粘膜的影响，在３个组中慢性胃炎的炎症程度与炎症活动性有显著性差异。２个中毒组间无显著性差异。结果表明在高氟区和高氟砷区患者的胃粘膜层病理改变主要是任性氟中毒引起，单纯性砷中毒并无协同作用。     

胶态果胶铋对实验性大鼠急性胃炎及兔慢性胃炎疗效的观察

果胶铋是一种新型的铋制剂，实验发现：０．５ｇ／ｋｇ／ｄ果胶铋灌胃大鼠能够明显减轻由ＨＣＩ引起的急性胃炎胃粘膜的病变程度；同时还发现，０．２５／ｋｇ／ｄ果胶铋灌胃家兔对兔实验性变态反应性胃炎有明显的治疗作用，能显著减小病变面积，减轻或消除胃粘膜炎症，且未见溃疡发生。其疗效与得乐疗效相比无显著性差异。     

热盐水致大鼠萎缩性胃炎胃粘膜组织细胞增殖与凋亡的实验研究

目的　研究热盐水灌胃导致的大鼠萎缩性胃炎胃粘膜组织中的凋亡细胞及增殖细胞表达状态 ,以探讨长期热咸饮食与慢性萎缩性胃炎发生的关系。方法　采用脱氧核糖核酸转移酶介导的缺口末端标记 (TUNEL)技术及免疫组织化学染色技术。细胞凋亡时DNA含量分析采用流式细胞检测技术。结果　①TUNEL检测细胞凋亡显示 :在热盐水所致的大鼠萎缩性胃炎中凋亡细胞数明显增多 ,在粘膜全层均可见到 ,呈弥漫性分布。萎缩性胃炎中凋亡细胞指数显著高于正常大鼠胃粘膜 (P <0 .0 5) ;②免疫组化法检测显示 :增殖细胞核抗原 (PCNA)在热盐水灌胃所致的萎缩性胃炎中的表达率显著高于正常胃粘膜 (P <0 .0 5) ;③流式细胞检测显示 :萎缩性胃炎时 ,在G0 /G1峰前可见一个亚G0 /G1峰 ,也即凋亡细胞峰出现 ,而在正常胃粘膜时未显示亚G0 /G1峰。结论　热盐水灌胃可导致大鼠胃粘膜组织细胞增殖和细胞凋亡异常 ,其在热盐水所致的大鼠萎缩性胃炎发生中起重要作用。     

INVASIVE MUCORMYCOSIS WITH GASTRIC INVOLVEMENT IN A PATIENT WITH SEVERE ATHEROMATOUS VASCULAR DISEASE

Gastric mucormycosis involvement is a rare condition that usually occurs in inmunocompromised patients and frequently has a fatal outcome. We report the case of a 73‐year‐old woman admitted to the intensive care unit with severe bleeding after an acute pulmonary disease. Upper endoscopy disclosed wide and deep necrotic ulcers in the body and fundus of the stomach and greenish exudates with the antrum and the duodenum undamaged. Autopsy revealed an invasive mucormycosis and a severe atheromatosis. Several predisposing factors for mucormycosis infection have been reported until now. We postulate that ischemic gastritis could be a predisposing factor for colonization of zygomycete.     

非溃疡性消化不良的幽门螺杆菌研究

本研究旨在观察幽门螺杆菌（ＨＰ）在非溃疡性消化不良（ＮＵＤ）发病中的作用。结果显示，ＮＵＤ患者ＨＰ阳性率为８３．６％，ＨＰ感染率显著高于健康人（Ｐ＜０．０１）。提示幽门螺杆菌在非溃疡性消化不良发病机制中可能有重要意义。     

胃胆宁汤治疗胆汁反流性胃炎54例

目的:观察自拟胃胆宁汤治疗胆汁反流性胃炎的临床疗效。方法:选符合标准的该病患者82例,随机分为两组,治疗组54例予自拟胃胆宁汤,对照组28例用吗丁啉片及雷尼替丁,两组治疗4周为1疗程。结果:治疗组痊愈20例,显效13例,有效16例,无效5例,总有效率为90.74%(95%CI=83.01%～98.48%);对照组痊愈5例,显效6例,有效9例,无效8例,总有效率为71.43%(95%CI=54.70%～88.16%);两组综合疗效比较,有显著性差异(u=2.3027,P=0.0215)。结论:自拟胃胆宁汤治疗胆汁反流性胃炎疗效优于吗丁啉及雷尼替丁,其收益为OR=0.25(95%CI=0.07～0.87),NNT=5(95%CI=2.78～37.88)。     

Hp相关胃炎患者血清表皮生长因子（ECG）和β2—微球蛋白（β2—MG）水平研究

目的探索EGF和β2-MG在CSG -CAG -GC演变模式中的变化规律 ,探讨Hp对EGF和β2-MG有无影响。方法应用尿素酶试验法、血清学试验法和组织学诊断法 ,进行Hp检查 ,应用放射免疫法检测血清EGF及β2-MG水平。结果(一)EGF水平(μg/L) :(1)按CSG -CAG -GC逐渐升高 ,依次为0.3229±0.225 ,0.8823±0.2549,1.3999±0.8935,GC组高于CSG组 (P<0.01) ,也高于CAG组 (P<0.05) ,CAG组高于CSG组 (P<0.01)。(2)CSG患者Hp(+)组 (0.2404±0.1103)低于Hp( -)组 (0 .4492±0.2931) (P<0.01) ;CAG患者Hp(+)组 (0 .8119±0.279)低于Hp(- )组(1.0056±0.1704) ,GC患者Hp(+)组 (1.159±0 .9229)低于Hp(- )组(1 .4963±0 .9127) ,均无统计学差异 (P>0.05)。(二 ) β2-MG水平 (mg/l) :(1)按CSG -CAG -GC顺序增高 ,依次为 :1.659±0.4321 ,1 .9661±1 .0802,2.3431±0 .5951 ,GC组高于CSG组 (P<0.01),CAG组高于CSG组 ,GC组高于CAG组 ,均无统计学意义 (P>0.05)。(2)同一胃病Hp( +)组与Hp( -)组比较血清β2-MG水平均无明显差异 (P>0.05)。结论按CSG -CAG -GC ,EGF水平逐渐升高 ,β2-MG有此种趋势。Hp有降低EGF的作用 ,Hp对β2-MG水平无明显影响