Kovacević I, Ljubicić N, Cupić H, Doko M, Zovak M, Troskot B, Kujundzić M, Banić M
Division of Gastroenterology, Department of Medicine, Department of Pathology, Sestre Milosrdnice University Hospital, Zagreb, Croatia.
Acta Med Croatica. 2001;55(4-5):157-60.
Histopathologic and clinical data strongly suggest a causal relation between Helicobacter pylori infection and gastritis, peptic ulcer disease, or both. However, little has been written about the potential association between H. pylori infection and Brunner's gland adenoma. Therefore, we carried out a prospective study to determine the presence of H. pylori infection among patients with Brunner's gland adenoma. From November 1996 till October 1999, 19100 patients who had undergone upper gastrointestinal endoscopy at two clinical centers in Zagreb, Croatia, were candidates for participation in the study. Brunner's gland adenoma was diagnosed on the basis of histologic samples taken from the polyp (four patients) or after the entire polyp was made available upon endoscopic removal (three patients). When all endoscopic examinations had been performed, biopsy samples were taken from the antrum and body of the stomach, so that gastritis could be classified and H. pylori determined by histology. Biopsy samples were also taken from the duodenal bulb to verify duodenitis. Two other samples were taken from the antrum for rapid urease test. The patients were considered positive for H. pylori when both histology and rapid urease test were positive. Brunner's gland adenoma was diagnosed in seven patients (five women and two men; median age, 49 yrs). Five (71%) patients with diagnosed Brunner's gland adenoma had concurrent H. pylori infection. Duodenitis associated with gastric metaplasia was observed in six patients. Complete eradication of H. pylori was achieved in only two patients. Symptoms disappeared or markedly diminished in all patients with significant improvement during therapy or immediately upon endoscopic removal of the polyp. Although limited by a very small number of patients, our results suggest that concurrent H. pylori infection is very common in patients with Brunner's gland adenoma. However, the role of H. pylori infection in the pathogenesis and development of Brunner's gland hyperplasia remains unclear.
组织病理学和临床数据有力地表明，幽门螺杆菌感染与胃炎、消化性溃疡病或两者之间存在因果关系。然而，关于幽门螺杆菌感染与布伦纳腺腺瘤之间的潜在关联，相关论述甚少。因此，我们开展了一项前瞻性研究，以确定布伦纳腺腺瘤患者中幽门螺杆菌感染的情况。1996年11月至1999年10月，在克罗地亚萨格勒布的两个临床中心接受上消化道内镜检查的19100名患者参与了本研究。布伦纳腺腺瘤根据取自息肉的组织学样本（4例患者）或在内镜切除整个息肉后（3例患者）进行诊断。所有内镜检查完成后，从胃窦和胃体取活检样本，以便对胃炎进行分类并通过组织学确定幽门螺杆菌。还从十二指肠球部取活检样本以证实十二指肠炎症。另外从胃窦取两份样本进行快速尿素酶试验。当组织学和快速尿素酶试验均为阳性时，患者被视为幽门螺杆菌阳性。7例患者（5名女性和2名男性；中位年龄49岁）被诊断为布伦纳腺腺瘤。5例（71%）诊断为布伦纳腺腺瘤的患者同时存在幽门螺杆菌感染。6例患者观察到与胃化生相关的十二指肠炎症。仅2例患者实现了幽门螺杆菌的完全根除。所有患者的症状消失或明显减轻，治疗期间或内镜切除息肉后立即有显著改善。尽管本研究受限于患者数量极少，但我们的结果表明，布伦纳腺腺瘤患者中同时存在幽门螺杆菌感染非常常见。然而，幽门螺杆菌感染在布伦纳腺增生的发病机制和发展中的作用仍不清楚。
