León-Barúa R
Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Perú.
Acta Gastroenterol Latinoam. 2000;30(5):491-6.
It is highly probable that nutritionally-related geographic and socioeconomic factors may modulate the conversion of early stages of Helicobacter pylori-associated chronic active gastritis (chronic superficial gastritis [CSG] and chronic deep gastritis [CDG]) to chronic atrophic gastritis (CAG). The factors would be diets low in antioxidant vitamins and other micronutrients. In regions of the world and population groups with high socioeconomic level in which these modulating factors are absent, chronic active gastritis tends to stay in its early stages of CSG or CDG and to predispose to duodenal ulcer. On the contrary, in regions and population groups with low socioeconomic level in which the modulating factors are present, the frequency of CAG increases markedly. When CAG becomes severe and diffuse, hypochlorhydria ensues. Hypochlorhydria decreases the predisposition to duodenal ulcer, while CAG, a precancerous lesion, predisposes to gastric cancer of the intestinal type. The real role of the modulating factors already mentioned could be elucidated doing a multicentric study to determine endoscopically and histologically, in large series of dyspeptic patients from various regions of the world and with different socioeconomic levels, prevalence rates of duodenal ulcer, gastric ulcer, gastric cancer, Helicobacter pylori-associated CAG and intestinal metaplasia of the gastric mucosa, and to correlate these prevalence rates with blood levels of antioxidant capacity and related micronutrients. Latin America, because of its diversity in regions, geographic characteristics and population socioeconomic levels, seems to be the ideal place to conduct a study of that type. If the study could be performed, it would undoubtedly constitute an important contribution to a better understanding of Helicobacter pylori-associated gastroduodenal pathology.
营养相关的地理和社会经济因素很可能会调节幽门螺杆菌相关性慢性活动性胃炎（慢性浅表性胃炎[CSG]和慢性萎缩性胃炎[CDG]）早期阶段向慢性萎缩性胃炎（CAG）的转变。这些因素可能是抗氧化维生素和其他微量营养素含量低的饮食。在世界上一些地区以及社会经济水平较高的人群中，由于缺乏这些调节因素，慢性活动性胃炎往往停留在CSG或CDG的早期阶段，并易引发十二指肠溃疡。相反，在存在调节因素的社会经济水平较低的地区和人群中，CAG的发生率会显著增加。当CAG变得严重且弥漫时，就会出现胃酸过少。胃酸过少会降低患十二指肠溃疡的易感性，而CAG作为一种癌前病变，则易引发肠型胃癌。通过多中心研究，在内镜和组织学上确定来自世界不同地区、社会经济水平各异的大量消化不良患者中十二指肠溃疡、胃溃疡、胃癌、幽门螺杆菌相关性CAG和胃黏膜肠化生的患病率，并将这些患病率与抗氧化能力和相关微量营养素的血液水平相关联，可能会阐明上述调节因素的实际作用。拉丁美洲由于其地区、地理特征和人群社会经济水平的多样性，似乎是进行此类研究的理想之地。如果能够开展这项研究，无疑将为更好地理解幽门螺杆菌相关性胃十二指肠病理学做出重要贡献。
