McColl K E L
Section of Medicine, Western Infirmary, Glasgow G11 6NT, UK.
Aliment Pharmacol Ther. 2004 Dec;20 Suppl 8:36-9. doi: 10.1111/j.1365-2036.2004.02227.x.
There is substantive epidemiological evidence of a negative association between Helicobacter pylori infection and reflux disease and its malignant complications. A plausible mechanism by which the infection might protect against reflux disease is by its propensity to produce atrophic gastritis and consequently reduce gastric acid secretion. Gastric acid is a key factor in the pathophysiology of reflux oesophagitis. It is well recognised that acid secretion decreases with age in H. pylori infected populations whereas acid secretion is maintained throughout life in H. pylori negative populations. The tendency for H. pylori infection to induce atrophy and reduce acid secretion is more marked in Eastern Europe and the Far East than in Western Europe, and this may be due to the influence of environmental and host genetic co-factors. This difference may also explain why the negative association between H. pylori infection and reflux disease is more marked in these areas than in Western Europe. If H. pylori infection is indeed protecting against reflux disease, then one would predict a rise in incidence of this disease and its malignant complications in these Eastern countries as the incidence of H. pylori infection decreases.
有大量流行病学证据表明幽门螺杆菌感染与反流性疾病及其恶性并发症之间存在负相关。该感染可能预防反流性疾病的一种合理机制是其易于引发萎缩性胃炎并因此减少胃酸分泌。胃酸是反流性食管炎病理生理学中的一个关键因素。众所周知，在感染幽门螺杆菌的人群中，胃酸分泌会随着年龄增长而减少，而在未感染幽门螺杆菌的人群中，胃酸分泌在一生中都会维持。幽门螺杆菌感染诱发萎缩和减少胃酸分泌的倾向在东欧和远东地区比在西欧更为明显，这可能是由于环境和宿主遗传共同因素的影响。这种差异也可能解释了为什么幽门螺杆菌感染与反流性疾病之间的负相关在这些地区比在西欧更为明显。如果幽门螺杆菌感染确实能预防反流性疾病，那么可以预测，随着幽门螺杆菌感染率在这些东方国家下降，这种疾病及其恶性并发症的发病率将会上升。
