Vieth M, Masoud B, Meining A, Stolte M
Institute of Pathology, Bayreuth, Germany.
Digestion. 2000;62(4):225-31. doi: 10.1159/000007820.
Since Helicobacter pylori (Hp) infection provokes intestinal and gastric metaplasia, the question arises whether the specialized metaplasia (Barrett's mucosa (BM)) and dysplasia or carcinoma in Barrett's epithelium seen in gastro-oesophageal reflux disease (GORD) might not also be correlated with Hp infection, or whether the latter offers protection against Barrett's oesophagus and Barrett's adenocarcinoma.
Gastric and oesophageal biopsies obtained from a total of 2,201 patients were analysed retrospectively. 297 of these patients had GORD (age 53.5 +/- 13.4 years; m:f ratio 2.1:1), 1,192 patients had BM (age 62.8 +/- 14.6 years; m:f 2.3:1) with or without neoplasia. 1,054 of these patients were diagnosed as having BM alone, 138 patients having BM neoplasia (high-grade dysplasia or adenocarcinoma). Patients with BM and low-grade dysplasia were excluded from this study because of the uncertainty in differentiating low-grade dysplasia from regenerative epithelium. A total of 712 patients with non-ulcer dyspepsia (NUD; average age 40.0 +/- 16.1 years; m:f 0.3:1) served as a control group.
The percentage of Hp infection did not differ between patients with GORD with (53.3%)/without BM (51.4%) and neoplasia (47.8%), but is statistically significantly lower than in patients with NUD (65.7%).
Our analysis shows that patients with GORD and Hp infection have no increased risk for the development of BM or neoplasia in BM. Since Hp infection is significantly less frequent in GORD than in NUD patients, a protective effect of the Hp infection is a possibility worth discussing.
由于幽门螺杆菌（Hp）感染会引发肠化生和胃化生，因此出现了这样一个问题，即胃食管反流病（GORD）中所见的特殊化生（巴雷特黏膜（BM））以及巴雷特上皮中的发育异常或癌变是否也与Hp感染相关，或者后者是否能预防巴雷特食管和巴雷特腺癌。
对总共2201例患者的胃和食管活检样本进行了回顾性分析。其中297例患者患有GORD（年龄53.5±13.4岁；男女比例2.1:1），1192例患者患有BM（年龄62.8±14.6岁；男女比例2.3:1），伴有或不伴有肿瘤形成。这些患者中，1054例被诊断为仅患有BM，138例患有BM肿瘤（高级别发育异常或腺癌）。由于难以区分低级别发育异常与再生上皮，患有BM和低级别发育异常的患者被排除在本研究之外。共有712例非溃疡性消化不良（NUD）患者（平均年龄40.0±16.1岁；男女比例0.3:1）作为对照组。
患有/不患有BM的GORD患者与肿瘤形成患者中Hp感染的百分比无差异（分别为53.3%/51.4%和47.8%），但在统计学上显著低于NUD患者（65.7%）。
我们的分析表明，患有GORD且感染Hp的患者发生BM或BM肿瘤的风险并未增加。由于GORD患者中Hp感染的频率明显低于NUD患者，Hp感染的保护作用是一个值得探讨的可能性。
