Jedrychowski W, Popiela T, Drews M, Gabryelewicz A, Marlicz K, Misiunia P, Wajda Z, Matyja A, Nowak K, Ramroth H, Wahrendorf J
Collegium Medicum, Jagiellonian University, Kraków.
Pol J Pathol. 1999;50(4):289-95.
The purpose of the study was to assess risk factors for intestinal metaplasia arising from H. pylori-related chronic gastritis in a subset of the population referred to endoscopic examinations due to dyspeptic complaints. We aimed specifically to establish whether H. pylori itself may be responsible for the occurrence of intestinal metaplasia and to which extent the metaplasia may be associated with life style factors such as cigarette smoking, alcohol consumption or dietary habits. The study was carried out in a sample of 1290 outpatients referred for the first time to gastroenterologic outpatient clinics in 6 university centers in Poland. The study methods covered standardized health interviews, endoscopy and histology of gastric antral specimens taken at endoscopy. The interviews performed by trained interviewers sought information on tobacco and alcohol intake, diet, socioeconomic status, and other variables. In non-ulcer dyspepsia subjects there was 54.9% H. pylori related gastritis and 25.1% of non-H. pylori-related gastritis. The corresponding rates in the group of ulcer dyspepsia were 67.5% and 20.5%. The increased risk of chronic gastritis in antrum was associated with Helicobacter pylori infection (OR = 2.28; 95% CI:1.93-2.69), and with gastric peptic ulcer (OR = 1.88; 95% CI:1.20-2.94). In the non-ulcer dyspepsia the prevalence of metaplasia was 11.1% and in ulcer dyspepsia 19.7%. The risk of intestinal metaplasia within antrum depended greatly upon the presence of gastric peptic ulcer (OR = 3.85; 95% CI:2.35-6.32) and increased with age (OR = 1.05; 95% CI:1.04-1.07), smoking cigarettes currently or in the past (OR = 1.42; 95% CI:1.10-1.84), higher frequency of drinking vodka (OR = 1.32, 95% CI:1.01-1.75) and antral chronic gastritis (OR = 1.31; 95% CI:1.00-1.70), however, it was inversely related to daily consumption of fresh fruits or vegetables (OR = 0.59; 95% CI:0.38-0.93). The results of the study suggest that there is no sufficient evidence supporting the hypothesis about an association between H. pylori gastritis and intestinal metaplasia, however, the transition of gastritis to metaplasia depends greatly on life style factors such as cigarette smoking or vodka drinking and is impeded by daily consumption of fresh fruits or vegetables.
本研究的目的是评估因消化不良症状而接受内镜检查的部分人群中，幽门螺杆菌相关慢性胃炎引发肠化生的风险因素。我们特别旨在确定幽门螺杆菌本身是否可能导致肠化生的发生，以及肠化生在多大程度上可能与吸烟、饮酒或饮食习惯等生活方式因素相关。该研究在波兰6所大学中心首次转诊至胃肠病门诊的1290名门诊患者样本中进行。研究方法包括标准化健康访谈、内镜检查以及内镜检查时采集的胃窦标本的组织学检查。由经过培训的访谈者进行的访谈收集了有关烟草和酒精摄入、饮食、社会经济地位及其他变量的信息。在非溃疡性消化不良患者中，54.9%为幽门螺杆菌相关性胃炎，25.1%为非幽门螺杆菌相关性胃炎。溃疡型消化不良组的相应比例分别为67.5%和20.5%。胃窦部慢性胃炎风险增加与幽门螺杆菌感染相关（比值比=2.28；95%置信区间：1.93 - 2.69），也与胃溃疡相关（比值比=1.88；95%置信区间：1.20 - 2.94）。在非溃疡性消化不良患者中，化生的患病率为11.1%，在溃疡型消化不良患者中为19.7%。胃窦部肠化生的风险在很大程度上取决于胃溃疡的存在（比值比=3.85；95%置信区间：2.35 - 6.32），并随年龄增加而增加（比值比=1.05；95%置信区间：1.04 - 1.07），与目前或过去吸烟（比值比=1.42；95%置信区间：1.10 - 1.84）、饮用伏特加频率较高（比值比=1.32，95%置信区间：1.01 - 1.75）以及胃窦部慢性胃炎（比值比=1.31；95%置信区间：1.00 - 1.70）相关，然而，它与每日食用新鲜水果或蔬菜呈负相关（比值比=0.59；95%置信区间：0.38 - 0.93）。研究结果表明，没有足够证据支持幽门螺杆菌胃炎与肠化生之间存在关联的假设，然而，胃炎向化生的转变在很大程度上取决于吸烟或饮用伏特加等生活方式因素，并且每日食用新鲜水果或蔬菜会阻碍这种转变。
