胆汁返流对慢性胃炎胃黏膜病变的影响

目的探讨胆汁返流对慢性胃炎胃黏膜病变特征的影响。方法采用 2 4h胃腔内胆红素吸光度和pH值联合监测方法 ,检测 4 9例慢性胃炎患者 ,并将其分为胆汁返流阳性组和阴性组。观察胃体、胃角和胃窦黏膜活动性感染等各项病理改变 ,并分析胃内胆汁返流时间与胃黏膜病变特征和胃内pH >4时间之间的相关性。结果 4 9例慢性胃炎患者中 ,38例胃内存在胆汁返流 ,11例不存在胃内胆汁返流。胆汁返流组全胃黏膜病变均较无胆汁返流组严重 ;胆汁返流时间与近端胃黏膜病变呈正相关 ,与pH >4时间无明显相关。结论胆汁返流是慢性胃炎患者全胃黏膜病变的重要病因之一 ,可能会促进H .pylori定植范围向胃体蔓延 ,从而加重近端胃黏膜损伤 ,对胃黏膜酸暴露情况没有显著影响

Influences of Bile Reflux on Profile of Gastric Mucosal Lesions in Chronic Gastritis

Objective To investigate the influences of bile reflux on profiles of gastric mucosal lesions in patients with dyspepsia or chronic gastritis. Methods A total of 49 patients with dyspepsia and chronic gastritis underwent 24 h ambulatory and simultaneous monitoring of intragastric bilirubin absorbance and pH values, and then they were divided into bile reflux positive group and bile reflux negative group. Severity of pathological changes in gastric mucosa including active inflammation, chronic inflammation, intestinal metaplasia, atrophy and dysplasia as well as H. pylori(Hp) infection at the corpus, incisura and antrum was determined, respectively, according to the update Sydney system criteria. The profiles of gastric mucosal lesions in the two groups were compared, and correlations between time-percentage of gastric bilirubin absorbance >0.14 and severity of gastric mucosal lesions as well as time-percentage of gastric pH>4 were analyzed, respectively. Results Thirty-eight patients were bile reflux positive and 11 patients were bile reflux negative. In dyspepsia patients with bile reflux, the mucosal lesions such as active inflammation, chronic inflammation, intestinal metaplasia, atrophy or H.pylori infection in the whole stomach, especially in the corpus and incisura, were significantly more severe than those in patients without bile reflux. Moreover, the bile reflux time was well correlated with the severity of pathological changes of gastric mucosa as well as Hp colonization in the near-end stomach, especially in the corpus region. No relevance was found between the time of bile reflux and pH>4 in the gastric cavity. Conclusion Bile reflux contributes a lot to mucosal lesions in the whole stomach, and may facilitate HP colonization in the corpus region. Yet it has no influence on the acid-exposing status of gastric mucosa in patients with dyspepsia or chronic gastritis.