胆汁反流和幽门螺杆菌感染在远端胃切除术后残胃炎发生中的作用

胆汁反流和幽门螺杆菌（H．pylori）感染是远端胃切除术后残胃炎发生的致病因素，但其确切的作用机制尚未明了。目的：明确胆汁反流和H．pylori感染与远端胃切除术后残胃黏膜炎症的相关性。方法：调查281例胃远端切除术后1年以上接受内镜随访的患者，除外胃镜检查发现恶性肿瘤者。内镜下观察残胃炎严重程度；根据炎症和活动性等指标评估残胃黏膜组织学严重程度。观察胆汁反流和H．priori感染对残胃炎内镜下表现和组织学炎症的影响。结果：81．1％的患者具有1级和1级以上程度的内镜下残胃炎，其H．pylori感染率和胆汁反流发生率均显著高于内镜下无明显炎症的患者（分别为20．6％对1．9％，P〈0．01和88．6％对24．5％，P〈0．0001）。有明显胆汁反流的各级残胃炎患者，胃黏膜慢性炎症和活动性程度与无明显胆汁反流的患者相比无显著性差异（P均〉0．05）；但伴有H．pylori感染的各级残胃炎患者，炎症和活动性分数均显著高于H．pylori阴性患者（P均〈0．05）。结论：远端胃切除术后胆汁反流发生率高，而H．pylori感染率降低。胆汁反流加重残胃炎内镜下炎症，而H．pylori感染与残胃炎内镜下和组织学炎症均相关。

Role of Bile Reflux and Helicobacter pylori Infection in the Pathogenesis of Remnant Gastritis After Distal Gastrectomy

Background: Bile reflux and Helicobacter pylori (H.pylori) infection are the two main pathogenic factors for remnant gastritis after distal gastrectomy. However, their exact role remains unclarified. Aims: To elucidate the association of bile reflux, (H.pylori)infection and inflammatory changes of the gastric remnant after distal gastrectomy. Methods: Two hundred and eighty-one patients evaluated by gastroscopy and excluded malignancies one year after distal gastrectomy were recruited. The degree of severity of the endoscopic remnant gastritis was divided into 4 grades. The severity of histopathological changes was divided into 4 grades as well, according to the inflammation and activity score. The effects of bile reflux, (H.pylori)infection on the endoscopic picture and the histopathological inflammatory changes were observed. Results: 81.1% of patients were of grade 1 or greater than grade 1 endoscopic remnant gastritis. The prevalences of bile reflux and(H.pylori)infection in patients with remnant gastritis were higher than those in patients without (20.6% vs. 1.9%, P<0.01 and 88.6% vs. 24.5%, P<0.0001, respectively=. There was no significant difference in the degree of severity of histopathological inflammation and activity between those with or without bile reflux (P all >0.05). However, the severity score of histopathological inflammation and activity was significantly higher in patients with(H.pylori)infection than in those without (P all <0.05=. Conclusions: The prevalence of bile reflux is high and that of(H.pylori)infection is low after distal gastrectomy. Bile reflux exacerbates the severity of endoscopic remnant gastritis, whereas(H.pylori)infection aggravates both the endoscopic remnant gastritis and the histopathological inflammation and activity.