Edge J M, Schneider J W, Moore S W
Departments of General Surgery, Anatomical Pathology and Paediatric Surgery, University of Stellenbosch, Tygerberg, W. Cape.
S Afr J Surg. 2001 Aug;39(3):80-2.
Meckel's diverticula (MD) with areas of gastric heterotopia (metaplasia) are more likely to become symptomatic than those that contain mucosa of purely an intestinal type. Helicobacter pylori has been associated with the pathogenesis of various diseases. The aim of the study was to evaluate whether H. pylori could be identified within metaplastic gastric mucosa in MD. A retrospective evaluation of the histopathological features and the clinical presentation of patients with MD was undertaken. The study group included 32 cases (20 paediatric and 12 adults). The commonest modes of presentation were acute pain (25%), obstruction (19%), bleeding (12.5%) and hernias (9%). On histological examination, heterotopic gastric mucosa was noted to be present in 12 cases. Of these, 3 specimens were noted to have H. pylori organisms present using a specific immunostaining technique. Two patients had concurrent gastric biopsies; one stained positively for H. pylori but the second (1 mm biopsy) was rapid urease-test positive only. In conclusion, the study provides strong evidence that H. pylori may colonise heterotopic gastric mucosa in a minority of MD. H. pylori is apparently not involved in the pathogenesis of most cases of complicated MD. Nonetheless, all 3 patients who had evidence of H. pylori were symptomatic.
伴有胃异位（化生）区域的梅克尔憩室（MD）比那些仅含有纯肠型黏膜的梅克尔憩室更易出现症状。幽门螺杆菌与多种疾病的发病机制有关。本研究的目的是评估在MD的化生胃黏膜中是否能检测到幽门螺杆菌。对MD患者的组织病理学特征和临床表现进行了回顾性评估。研究组包括32例患者（20例儿童和12例成人）。最常见的表现方式为急性疼痛（25%）、梗阻（19%）、出血（12.5%）和疝（9%）。组织学检查发现，12例存在异位胃黏膜。其中，使用特定免疫染色技术发现3份标本中有幽门螺杆菌。2例患者同时进行了胃活检；1例幽门螺杆菌染色阳性，另1例（1毫米活检组织）仅快速尿素酶试验呈阳性。总之，该研究提供了有力证据，表明在少数MD中幽门螺杆菌可能定植于异位胃黏膜。幽门螺杆菌显然不参与大多数复杂性MD病例的发病机制。尽管如此，所有3例有幽门螺杆菌证据的患者均有症状。
