Awad Richard A, Camacho Santiago
Esophageal Section, Experimental Medicine and Motility Unit, Mexico City General Hospital, DF, Mexico.
J Gastroenterol. 2002;37(4):247-54. doi: 10.1007/s005350200031.
The association of H. pylori and hiatal hernia in patients with gastroesophageal reflux disease, in terms of acidity and esophageal motility, is not well defined. The purpose of this work was to assess whether, in patients with gastroesophageal reflux, the presence of H. pylori and hiatal hernia affects the severity of esophagitis.
Reflux symptoms, endoscopy, H. pylori, esophageal manometry, and 24-h pH monitoring were evaluated in 37 patients with esophageal reflux and 14 healthy volunteers.
A total of 75.6% of patients with esophageal reflux was positive for H. pylori; 81% had hiatal hernia, and only 43.2% showed an acid score by 24-h pHmetry. Esophageal reflux patients with H. pylori, hiatal hernia, and an acid score demonstrated higher acid parameters compared with those in healthy volunteers. Patients with an acid score who were negative for H. pylori tended toward more acid reflux events than patients with an acid score who were positive for H. pylori, a difference that did not reach significance. The same situation existed with patients with an acid score and hiatal hernia who were negative for H. pylori, but the tendency did not achieve significance. Independent analysis of patients with Savary-Miller stage II and III esophagitis showed results that were not different from the combined analysis of stage II and III patients. Amplitude and contraction-duration parameters of the esophageal wave, and the number of high-pressure and prolonged contractions were not different among the reflux groups. Wave amplitude in the lower third of the esophagus was significantly lower in esophagitis stage III patients with hiatal hernia and in esophagitis stage II and III patients, combined, with H. pylori, compared with findings in the healthy volunteers.
These results suggest that H. pylori and hiatal hernia in patients with esophageal reflux do not constitute risk factors that affect the severity of esophagitis.
在胃食管反流病患者中，幽门螺杆菌与食管裂孔疝在酸度和食管动力方面的关联尚未明确界定。本研究的目的是评估在胃食管反流患者中，幽门螺杆菌和食管裂孔疝的存在是否会影响食管炎的严重程度。
对37例食管反流患者和14名健康志愿者进行了反流症状、内镜检查、幽门螺杆菌检测、食管测压和24小时pH监测。
食管反流患者中，75.6%幽门螺杆菌检测呈阳性；81%有食管裂孔疝，且仅43.2%的患者通过24小时pH监测显示有酸反流评分。与健康志愿者相比，有幽门螺杆菌感染、食管裂孔疝且有酸反流评分的食管反流患者显示出更高的酸参数。酸反流评分呈阳性但幽门螺杆菌检测呈阴性的患者比酸反流评分呈阳性且幽门螺杆菌检测呈阳性的患者有更多的酸反流事件倾向，不过差异未达到显著水平。酸反流评分呈阳性且食管裂孔疝但幽门螺杆菌检测呈阴性的患者也存在同样情况，但该倾向未达到显著水平。对Savary-Miller II期和III期食管炎患者进行的独立分析显示，结果与II期和III期患者的综合分析无差异。反流组之间食管波的振幅和收缩持续时间参数，以及高压和延长收缩的次数没有差异。与健康志愿者相比，有食管裂孔疝的III期食管炎患者以及合并有幽门螺杆菌感染的II期和III期食管炎患者中，食管下三分之一处的波幅显著更低。
这些结果表明，食管反流患者中的幽门螺杆菌和食管裂孔疝并非影响食管炎严重程度的危险因素。
