Johannesson Kristina Ahsberg, Hammar Eric, Staël von Holstein Christer
Department of Surgery, University Hospital, Lund, Sweden.
Eur J Gastroenterol Hepatol. 2003 Jan;15(1):35-40. doi: 10.1097/00042737-200301000-00007.
Bile reflux is thought to be responsible for reflux gastritis and stump carcinoma occurring after partial gastrectomy for peptic ulcer. Gastritis and gastric carcinoma are also correlated with Helicobacter pylori. The aim of this study was to investigate whether diversion of enteric reflux and the presence of H. pylori infection alter long-term histological developments in the gastric remnant.
Twenty-nine patients partially gastrectomized for peptic ulcer were reoperated on with re-resection and a Roux-en-Y reconstruction because of reflux gastritis (12 patients) or severe dysplasia/early gastric cancer (17 patients). The resected specimens and subsequent biopsies from the new anastomotic region taken at endoscopies 5-17 years after reoperation were evaluated regarding the presence of H. pylori, the grade of active and non-active chronic gastritis, and the premalignant changes--atrophy, intestinal metaplasia and dysplasia.
A progression of active chronic gastritis, atrophy, intestinal metaplasia and dysplasia was seen after re-resection and Roux-en-Y reconstruction. Non-active chronic gastritis remained unchanged. The development was, in general, independent of H. pylori infection.
Enteric reflux may perhaps induce a histological transformation of the gastric mucosa that cannot be reversed, even if the reflux is diverted. In our study, H. pylori infection had no impact on the histological development. Factors other than enteric reflux and H. pylori infection might also be of importance.
胆汁反流被认为是导致消化性溃疡行胃部分切除术后发生反流性胃炎和残胃癌的原因。胃炎和胃癌也与幽门螺杆菌有关。本研究的目的是调查肠反流改道和幽门螺杆菌感染的存在是否会改变胃残端的长期组织学发展。
29例因消化性溃疡行胃部分切除术的患者，因反流性胃炎（12例）或严重发育异常/早期胃癌（17例）接受再次手术，行再次切除及Roux-en-Y重建术。对再次手术后5 - 17年在内镜检查时从新吻合区域获取的切除标本及后续活检组织进行评估，观察幽门螺杆菌的存在情况、活动性和非活动性慢性胃炎的分级以及癌前病变——萎缩、肠化生和发育异常。
再次切除及Roux-en-Y重建术后可见活动性慢性胃炎、萎缩、肠化生和发育异常进展。非活动性慢性胃炎保持不变。总体而言，这种发展与幽门螺杆菌感染无关。
肠反流可能会诱导胃黏膜发生无法逆转的组织学转变，即使反流改道。在我们的研究中，幽门螺杆菌感染对组织学发展没有影响。除肠反流和幽门螺杆菌感染外的其他因素可能也很重要。
