幽门螺杆菌感染、十二指肠胃化生及其与溃疡复发的关系。

Gisbert J P, Blanco M, Cruzado A I, Pajares J M

Department of Gastroenterology, University Hospital of La Princesa, Madrid, Spain.

Eur J Gastroenterol Hepatol. 2000 Dec;12(12):1295-8. doi: 10.1097/00042737-200012120-00006.

OBJECTIVE

To study the prevalence of Helicobacter pylori (H. pylori) infection and gastric metaplasia (GM) in the duodenum a large group of patients with duodenal ulcer was evaluated to determine whether these factors are related to the number of ulcer recurrences.

METHODS

Three hundred and seven patients diagnosed by endoscopy as having active duodenal ulcers were studied. At endoscopy, all patients had gastric biopsies taken for histology, the rapid urease test and culture. Three duodenal biopsies were also taken and processed for histology (haematoxylin & eosin, Giemsa, Warthin-Starry, and PAS stain).

RESULTS

GM and H. pylori in the duodenum was identified in 73% (68-78%) and 66% (60-71%) of the cases, respectively. All patients with H. pylori in the duodenum also had GM at this location, while areas with GM but without H. pylori were described. The kappa statistic for concordance between GM and H. pylori at the duodenum was 0.82. The prevalence of GM and H. pylori, depending on the number of ulcer recurrences, was: 1st episode, 34% and 27%, respectively; 2nd episode, 84% and 80%; and > or = 3rd episode, 90% and 79% (P < 0.001 when comparing 1st vs 2nd or > or = 3rd episode). In the multivariate analysis, age and number of ulcer recurrences correlated both with GM and with H. pylori in the duodenum. Chronic duodenitis was demonstrated in all duodenal biopsies, 87% being active chronic duodenitis. H. pylori in the duodenum was more frequent in patients with active duodenitis (73%) than in those with inactive duodenitis (13%) (P < 0.001).

CONCLUSIONS

Patients with recurrent ulcer disease have a higher prevalence of both GM and H. pylori infection in the duodenum, suggesting that these two factors are related with the chronicity and recurrence of duodenal ulcer disease. H. pylori infection in the duodenum always appears in areas of GM, although GM is not necessarily colonized by the organism. H. pylori infection cannot be excluded based only on the results of duodenal biopsies, as false negative results at this area are frequent.

目的

为研究幽门螺杆菌（H. pylori）感染及十二指肠胃化生（GM）的患病率，对一大组十二指肠溃疡患者进行评估，以确定这些因素是否与溃疡复发次数相关。

方法

对307例经内镜诊断为活动性十二指肠溃疡的患者进行研究。在内镜检查时，对所有患者进行胃活检以进行组织学检查、快速尿素酶试验和培养。还取了3块十二指肠活检组织进行组织学处理（苏木精和伊红染色、吉姆萨染色、沃辛 - 斯塔里染色和PAS染色）。

结果

十二指肠GM和H. pylori的检出率分别为73%（68 - 78%）和66%（60 - 71%）。所有十二指肠中有H. pylori的患者在此部位也有GM，同时也描述了有GM但无H. pylori的区域。十二指肠GM和H. pylori一致性的kappa统计值为0.82。根据溃疡复发次数，GM和H. pylori的患病率分别为：首次发作，分别为34%和27%；第二次发作，分别为84%和80%；以及≥第三次发作，分别为90%和79%（首次发作与第二次或≥第三次发作比较时，P < 0.001）。在多变量分析中，年龄和溃疡复发次数与十二指肠的GM和H. pylori均相关。所有十二指肠活检均显示有慢性十二指肠炎，87%为活动性慢性十二指肠炎。十二指肠中有H. pylori的患者在活动性十二指肠炎患者中更为常见（73%），而在非活动性十二指肠炎患者中则较少见（13%）（P < 0.001）。