Kyzekova J, Mour J
Private Outpatient Department of Internal Medicine and Gastroenterology, Podborany, Czech Republic.
Hepatogastroenterology. 1999 May-Jun;46(27):2048-56.
BACKGROUND/AIMS: Eradication therapy results in the control of gastritis. Little is known about its influence on changes in the topographic distribution and regression of specific mucosal alterations in patients with dyspepsia. Our previous study has shown the complex pathological changes in the cardia, corpus and antrum in patients with Helicobacter pylori (H. pylori) infection and NUD. To determine the effect of eradication therapy on the development of histological changes in the lower esophagus, cardia, corpus and antrum in patients with nonulcerous dyspepsia, 3 and 6 months after therapy.
Two hundred and fifty-one consecutive patients with dyspepsia (the presence of ulcer and stomach malignancy was ruled out) and H. pylori infection were followed up in a prospective study. Every patient underwent endoscopic examination with eight biopsies taken (antrum, corpus, cardia and lower esophagus) before, and 3 and 6 months after eradication therapy (Pantoprazole 40 mg daily, Amoxycilline 1000 mg b.i.d., Clarithromycine 500 mg b.i.d.). The biopsies were stained by (H&E) and Giemsa's staining modified for H. pylori detection. The inflammation, its activity, H. pylori and other mucosal alterations were investigated semi-quantitatively and assessed according to the Sydney system.
In the cardia, corpus and antrum, significant decrease in chronic inflammation, and H. pylori activity (p<0.001) was found. Atrophy was insignificantly higher in the cardia (p<0.05), whereas in the corpus (p<0.05) and antrum (p<0.001) it was lower. Intestinal metaplasia remained unchanged in the cardia and in the antrum; in the corpus an insignificant decrease was found. The number of patients with foveolar hyperplasia in the cardia was higher, but this increase was not significant, in contrast to the corpus (p<0.01) and antrum (p<0.05). This was especially the case between the first and the second visit. Regression of lymphoid follicles was significant in the cardia (p<0.001) and in the antrum (p<0.01), whereas their quantity in the corpus was unchanged. In the corpus and antrum, a significant increase of chemical gastropathy between the second and third visit (p<0.001) was found. The same applied for hemorrhages found in the esophagus papillae (p<0.001).
Eradication therapy was closely associated with a significant decrease of inflammation activity and H. pylori infection. Chronic inflammation, mucosal atrophy and intestinal metaplasia persisted, even though their intensity was decreased, and signs of chemical gastropathy with hemorrhages in the esophageal papillae were found.
背景/目的：根除治疗可控制胃炎。关于其对消化不良患者特定黏膜改变的地形分布变化及消退的影响，人们了解甚少。我们之前的研究已显示幽门螺杆菌（H. pylori）感染和非溃疡性消化不良（NUD）患者的心、体、窦部存在复杂的病理变化。为确定根除治疗对非溃疡性消化不良患者治疗后3个月和6个月时食管下段、贲门、胃体和胃窦部组织学变化发展的影响。
对251例连续的消化不良患者（排除溃疡和胃恶性肿瘤）及H. pylori感染患者进行前瞻性研究。每位患者在根除治疗前、治疗后3个月和6个月接受内镜检查，并取8处活检组织（胃窦、胃体、贲门和食管下段）（泮托拉唑每日40 mg，阿莫西林1000 mg，每日两次，克拉霉素500 mg，每日两次）。活检组织用苏木精-伊红（H&E）染色及改良的吉姆萨染色以检测H. pylori。根据悉尼系统对炎症、其活性、H. pylori及其他黏膜改变进行半定量研究和评估。
在心、体、窦部，发现慢性炎症和H. pylori活性显著降低（p<0.001）。贲门部萎缩略高（p<0.05），而胃体部（p<0.05）和胃窦部（p<0.001）萎缩较低。贲门和胃窦部肠化生保持不变；胃体部有轻微下降。贲门部小凹增生患者数量较多，但与胃体部（p<0.01）和胃窦部（p<0.05）相比，这种增加不显著。尤其是在第一次和第二次就诊之间。贲门部（p<0.001）和胃窦部（p<0.01）淋巴滤泡消退显著，而胃体部淋巴滤泡数量未变。在胃体部和胃窦部，第二次和第三次就诊之间化学性胃病显著增加（p<0.001）。食管乳头出血情况也是如此（p<0.001）。
根除治疗与炎症活性和H. pylori感染的显著降低密切相关。慢性炎症、黏膜萎缩和肠化生持续存在，尽管其强度有所降低，且发现有食管乳头出血的化学性胃病迹象。
