Blaser M J
Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, and Medical Service, Department of Veterans Affairs Medical Center, Nashville, TN 37232-2605, USA.
J Infect Dis. 1999 Jun;179(6):1523-30. doi: 10.1086/314785.
Helicobacter pylori has apparently colonized the human stomach since time immemorial and is superbly adapted for persistence. Several genotypes, including cag+, are associated with increased risk of gastric and duodenal diseases. With modern life, for probably the first time in human history, there are large numbers of noncolonized persons. Duodenal ulceration has been present essentially for only 200 years; that its incidence rose just as H. pylori was waning is best explained by changes in gastric microecology. As H. pylori is disappearing, duodenal ulceration and gastric cancer rates are falling. However, more proximal diseases, gastroesophageal reflux (GERD), Barrett's esophagus, and adenocarcinomas of the gastric cardia and lower esophagus, are increasing; colonization with cag+ H. pylori strains appears protective against these diseases. Thus, in the 21st century, the continuing decline in H. pylori may lead to the disappearance of duodenal ulcers and distal gastric cancers and toward a marked increase in GERD, Barrett's esophagus, and esophageal adenocarcinoma.
幽门螺杆菌显然自远古时代起就已在人类胃部定植，并且对长期生存具有极强的适应性。包括cag+在内的几种基因型与胃和十二指肠疾病风险增加有关。在现代生活中，可能是人类历史上首次出现了大量未被该菌定植的人群。十二指肠溃疡基本上仅存在了200年；其发病率在幽门螺杆菌逐渐减少时上升，这最好用胃微生态的变化来解释。随着幽门螺杆菌的消失，十二指肠溃疡和胃癌的发病率正在下降。然而，更多位于近端的疾病，如胃食管反流病（GERD）、巴雷特食管以及贲门和食管下段腺癌，却在增加；cag+幽门螺杆菌菌株的定植似乎对这些疾病具有保护作用。因此，在21世纪，幽门螺杆菌的持续减少可能会导致十二指肠溃疡和远端胃癌消失，并使胃食管反流病、巴雷特食管和食管腺癌显著增加。
