Vakil N, Talley N J, Stolte M, Sundin M, Junghard O, Bolling-Sternevald E
Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Aliment Pharmacol Ther. 2006 Jul 1;24(1):55-63. doi: 10.1111/j.1365-2036.2006.02964.x.
The effect of Helicobacter pylori eradication on the development of gastro-oesophageal reflux disease is controversial. Aim To determine the incidence of symptoms of reflux disease and of erosive oesophagitis, and the relationship to changes in histological gastritis, in patients with non-ulcer dyspepsia over 12 months.
Six hundred and ninety-three patients in two similar randomized placebo controlled trials of H. pylori eradication in non-ulcer dyspepsia were studied. Symptoms were assessed using the validated Gastrointestinal Symptom Rating Scale during a 1-week run-in period, at 6 months and 12 months. Endoscopy was performed at baseline to exclude patients with pathology and at 3 months and 12 months to determine if oesophagitis was present. Gastric biopsies were scored using the modified Sydney Classification.
Patients without predominant heartburn, oesophagitis or ulcers at endoscopy were randomized to active (n = 297, omeprazole, amoxicillin and clarithromycin) treatment or to placebo/omeprazole (n = 306) for 1 week. The eradication rate was 82% in the active treatment group. Antrum-predominant gastritis (55%) was more frequently found than corpus-predominant gastritis (6%). In patients with antrum-predominant gastritis, heartburn and regurgitation scores improved significantly 12 months after eradication. Erosive oesophagitis developed in 15/232 patients in the eradication group (7%) compared with 2/227 (2%) in the control group, but there was no significant difference when adjusted for oesophagitis present at baseline.
Antrum-predominant gastritis is the most common pattern of gastritis seen in non-ulcer dyspepsia in Western populations. Heartburn and regurgitation improve after eradication therapy or placebo in patients with non-ulcer dyspepsia; the development of oesophagitis is uncommon.
幽门螺杆菌根除对胃食管反流病发展的影响存在争议。目的是确定非溃疡性消化不良患者在12个月内反流病症状和糜烂性食管炎的发生率，以及与组织学胃炎变化的关系。
对两项类似的非溃疡性消化不良幽门螺杆菌根除随机安慰剂对照试验中的693例患者进行了研究。在为期1周的导入期、6个月和12个月时，使用经过验证的胃肠道症状评分量表评估症状。在基线时进行内镜检查以排除有病变的患者，并在3个月和12个月时进行内镜检查以确定是否存在食管炎。胃活检采用改良的悉尼分类法进行评分。
内镜检查时无主要烧心、食管炎或溃疡的患者被随机分为积极治疗组（n = 297，奥美拉唑、阿莫西林和克拉霉素）或安慰剂/奥美拉唑组（n = 306），治疗1周。积极治疗组的根除率为82%。以胃窦为主的胃炎（55%）比以胃体为主的胃炎（6%）更常见。在以胃窦为主的胃炎患者中，根除后12个月烧心和反流评分显著改善。根除组232例患者中有15例（7%）发生糜烂性食管炎，而对照组227例中有2例（2%），但在对基线时存在的食管炎进行校正后无显著差异。
以胃窦为主的胃炎是西方人群非溃疡性消化不良中最常见的胃炎类型。非溃疡性消化不良患者在根除治疗或服用安慰剂后烧心和反流症状改善；食管炎的发生并不常见。
