幽门螺旋杆菌根除治疗对老年人Barrett食管复发的影响

目的 通过对经胃镜氩离子凝固消融技术(APC)治疗后老年Barrett食管(BE)患者进行胃镜随访,探讨根除幽门螺旋杆菌(Hp)治疗对食管黏膜恢复的影响及Hp感染与BE的关系.方法 将经胃镜及病理确诊的201例老年BE患者分为无Hp感染(对照组)组53例和Hp感染组148例,Hp感染组再随机分为感染1组和感染2组各74例.所有患者经APC治疗后,给予抑制胃酸治疗,奥美拉唑40 mg,2次/d,静脉滴注,连续7d;7d后改用奥美拉唑胶囊20mg,2次/d,早晚口服,总疗程2个月.感染2组同时给予根除Hp治疗,阿莫西林1000 mg,2次/d;克拉霉素500 mg,2次/d;替硝唑500 mg,2次/d,上述3种抗生素选用2种,共用2周.所有患者于治疗结束后第1、3、6、12、24个月进行胃镜及病理复查,并进行24 h食管pH监测.结果 3组患者APC治疗平均2.4次(1～3次),治疗后1个月所有患者BE黏膜消失,复层鳞状上皮完全修复;治疗后3个月,各组均有反流性食管炎(RE)和BE复发;治疗后6个月RE复发率明显上升,对照组为22.6%,感染1组和感染2组分别为12.2%和17.6%(χ2=61.28、59.00和43.96,P＜0.05);12个月BE复发率明显增加,对照组为22.6%,感染1组和感染2组分别为18.9%和23.0%(χ2=6.79、6.62和5.97,P＜0.05).治疗前3组患者均有病理性胃食管酸反流(DeMeester指数＞14.7),治疗后1个月DeMeester指数恢复正常,对照组为14.5±0.9,感染1组和感染2组分别为13.2±0.4和12.0±0.5(t=2.09、2.22和2.15,P＜0.05);治疗后6个月DeMeester指数明显升高(t=2.29、2.33和2.14,P＜0.05),但3组间差异无统计学意义(均P＞0.05).结论 胃窦部感染Hp的老年BE患者,在进行APC治疗同时可进行根除Hp治疗;APC联合根除Hp治疗对老年BE患者的远期预后与单独APC治疗无显著差别;APC治疗可完全清除BE上皮,长期应用抑制胃酸治疗可能延缓BE复发.

Relationship between recurrence of Barrett esophagus and Helicobacter pylori eradication therapy in the elderly

Objective To investigate the relationship between the recurrence of Barrett esophagus (BE) and Helicobacter pylori (Hp) eradication therapy, according to endoscopic follow-up outcomes in the elderly patients with BE after endoscopic argon plasma coagulation (APC). Methods A total of 201 elderly patients were enrolled to be treated with APC, including 53 patients without Hp infection (control group) and 148 cases with Hp infection (infection group), then the infection group was randomly divided into two groups: infection group A (n=74) and infection group B (n=74). After APC, all patients were given acid suppression therapy with omeprazole infusion 40 mg twice daily for 7 days, then omeprazole capsules 20 mg twice a day orally, the overall time was 2months. The patients in infection group B received Hp eradication therapy with two of the following three kinds of antibiotics for 2 weeks: amoxicillin 500 mg twice a day, clarithromycin 500 mg twice a day and tinidazole 500 mg twice a day. All patients received reexamination of endoscopy and pathology, and underwent 24-hour esophageal pH test 1, 3, 6, 12 and 24 months after treatment.Results By APC treatment for an average of 2.4 times (1-3 times), 1 month after treatment, all BE epithelium disappeared and stratified squamous epithelium was repaired completely. Reflux esophagitis (RE) and BE in some cases were found in 3 groups 3 months after therapy. The relapse incidence of RE was significantly increased at 6 months after therapy control group: 22.6%, infection group A:12.2o%and infection group B: 17. 6%, t = 2.21, 2.17 and 2.30,P＜0. 05]. At 12 months after therapy, the relapse incidence of BE was significantly increased control group: 22.6%, infection group A: 18.9% and infection group B: 23.0%, t=2.11, 2.19 and 2.32, P＜0. 05]. All patients presented pathological gastro-esophageal reflux (DeMeester index＞14.72) before treatment. At 1 month after therapy, all patients returned to normal DeMeester indexcontrol group: 14.5, infection group A: 15.2 and infection group B: 12.0, t=2.09, 2.22 and 2.15, P＜0. 05]. At 6 months after treatment, DeMeester index increased (t=2.29, 2.33 and 2.14, P＜0.05). But there were no significant differences among 3 groups (P＞0. 05). Conclusions The elderly BE patients with HP infection in gastric antrum can receive APC treatment plus Hp eradication treatment, but it has no significant effect on long-term prognosis for BE patients. APC treatment can completely remove BE epithelium, long-term acid suppression therapy may delay recurrence of BE.