老年人胃贲门炎病因学分析

目的：探讨老年人胃贲门炎的病因学及其转归。方法：经内镜及活检病理诊断为贲门炎，其临床及随访资料完整的共97例。内镜观察方法：贲门区定为齿状线以下0．5～4cm范围，凡有黏膜片状发红、充血、水肿、出血点、糜烂等炎症表现者，均取局部活检2块以上，行常规病理组织学检查。炎症程度、肠上皮化生、H.pylori感染按悉尼系统分类法确定。对伴随的胃部基础病变加以评估。结果：组织病理学显示97例均有不同程度的黏膜固有层慢性炎伴急性炎反应，其中轻一中度炎症68例(70．1％)，重度炎症29例(29．9％)。局部H.pylori感染者36例(37．1％)，伴胃其他部位H.pylori感染者65例(67．0％)。肠上皮化生33例(34．0％)。黏膜轻至中度萎缩者14例(14．3％)。所伴随的胃部基础病变有：慢性萎缩性胃炎75例(77．3％)，慢性浅表性胃炎22例(22．7％)，胃食管反流病66例(68．0％)。随访过程中发生贲门息肉27例(27．8％)，贲门糜烂伴局部癌变7例(7．2％)，局部癌变前半年组织学可有中至重度异型增生。结论：老年人胃食管反流病对贲门炎的形成起重要作用，其次为H.pylori感染，组织病理学显示，贲门黏膜炎以浅表性慢性炎为主，反复贲门糜烂有局部癌变倾向。

The etiologic investigation of inflammation in the gastric cardia in 97 elderly patients

Objective:To investigate the etiological agent and the prognosis of the inflammation in the gastric cardia in the aged. Methods:The carditis was identified by endoscopic findings,all biopsy specimens of the cardia were obtained below the Z-line within 4cm of the proximal stomach. The carditis had histological evidence of the grade of inflammation,H. pylori infection,intestinal metaplasia according to the updated Sydney classification.Results:All of the 97 cases had lamina propria mucosa inflammation,68(70.1%)were mild-moderate and 29(29.9%)were severe inflammation. 39(40.2%) had mucosa erosion,33(34.0%)had intestinal metaplasia. 36(37.1%)had H. pylori in cardia and 65 (67.0%) in other parts of the stomach. Background data were collected on age,diagnosis,symptoms,75(77.3%)had atrophic gastritis,66(68.0%)had GERD,27 (27.8%) had polypus of cardia,7(7.2%)cardia erosion became adenocarcinoma.Conclusions:Our data support that gastroesophageal reflux is the major cause of carditis,H. pylori infection as also being the etiologic agent for this disease in the group of patients. It should be emphasized that persistent erosion may be the risk factor for cardia adenocarcinoma.