León-Barúa Raúl, Recavarren-Arce Sixto, Chinga-Alayo Erick, Rodríguez-Ulloa Carlos, Taylor David N, Gotuzzo Eduardo, Kosek Margaret, Eza Dominique, Gilman Robert H
The Alexander von Humboldt Tropical Medicine Institute, Universidad Peruana Cayetano Heredia, Calle Honorio Delgado 430, San Martin de Porres, Lima 31, Peru.
Trans R Soc Trop Med Hyg. 2006 Jun;100(6):567-72. doi: 10.1016/j.trstmh.2005.09.013. Epub 2005 Dec 22.
Evidence has associated chronic infection by Helicobacter pylori with chronic gastritis, low gastric acid production and an increased risk of life-threatening cholera. However, the relationship of specific patterns of histological damage in the gastric mucosa associated with H. pylori infection and the occurrence of cholera has not been described. The purpose of this study was to compare the gastric pH and histopathological findings in gastric biopsies taken from patients with severe diarrhoeal disease due to Vibrio cholerae with those taken from a control (cholera-negative) population. Thirty-five H. pylori-positive patients who had severe dehydration from culture-confirmed cholera (cases) and 40 patients with H. pylori but with no history of cholera (controls) were recruited. Gastric pH was measured and multiple biopsies were taken from the gastric antrum and body for histopathological examination. The results revealed that patients with severe cholera had a significantly higher prevalence of hypochlorhydria at endoscopy compared with controls. Furthermore, cases had significantly more chronic atrophic gastritis (45.7% vs. 12.5%; P=0.002) and intestinal metaplasia (37.1% vs. 2.5%; P<0.01) in the gastric body than controls. Our findings suggest that the nature and location of these gastric lesions may predispose a subset of H. pylori-infected individuals to severe disease by V. cholerae.
有证据表明，幽门螺杆菌的慢性感染与慢性胃炎、胃酸分泌减少以及危及生命的霍乱风险增加有关。然而，幽门螺杆菌感染相关的胃黏膜组织学损伤的特定模式与霍乱发生之间的关系尚未见描述。本研究的目的是比较因霍乱弧菌导致严重腹泻病的患者与对照（非霍乱）人群的胃活检标本中的胃pH值和组织病理学发现。招募了35例经培养确诊为霍乱且有严重脱水的幽门螺杆菌阳性患者（病例组）和40例有幽门螺杆菌感染但无霍乱病史的患者（对照组）。测量胃pH值，并从胃窦和胃体多处取材进行组织病理学检查。结果显示，与对照组相比，严重霍乱患者在内镜检查时胃酸缺乏的患病率显著更高。此外，病例组胃体部的慢性萎缩性胃炎（45.7%对12.5%；P=0.002）和肠化生（37.1%对2.5%；P<0.01）明显多于对照组。我们的研究结果表明，这些胃部病变的性质和位置可能使一部分幽门螺杆菌感染个体易患霍乱弧菌所致的严重疾病。
