Correa P, Piazuelo M B
Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Dig Liver Dis. 2008 Jul;40(7):490-6. doi: 10.1016/j.dld.2008.02.035. Epub 2008 Apr 18.
This report describes the modalities of chronic gastritis induced by Helicobacter pylori infection in different populations. The full gamut of lesions representing the precancerous cascade is very prevalent in populations of low socioeconomic background experiencing very high gastric cancer risk, as seen in the Latin American Andes Mountains. In populations of high socioeconomic standards and high cancer risk, such as Japan and Korea, the precancerous cascade predominates and "early" cancers are also diagnosed frequently. Some reports describe frequent corpus atrophy, not prominent in the former group. The so-called African enigma is seen in populations of low socioeconomic standards, usually living at low altitudes, with high prevalence of infection but low frequency of cancer and precancerous lesions. In populations in transition from high to low cancer risk, duodenal ulcer and antral non-atrophic gastritis are frequently seen. In affluent societies at low risk of cancer, such as Western Europe, Australia and North America, mild non-atrophic gastritis associated with low virulence Helicobacter pylori genotypes predominate. The varied phenotypes of gastritis may reflect secular changes in the ecology of our species.
本报告描述了幽门螺杆菌感染在不同人群中诱发慢性胃炎的方式。代表癌前病变级联的一系列病变在胃癌风险极高的社会经济背景较低的人群中非常普遍，如拉丁美洲安第斯山脉地区所见。在社会经济水平高且癌症风险高的人群中，如日本和韩国，癌前病变级联占主导，“早期”癌症也经常被诊断出来。一些报告描述了胃体萎缩频繁出现，而在前一组人群中并不突出。所谓的“非洲之谜”见于社会经济水平较低、通常生活在低海拔地区、感染率高但癌症和癌前病变发生率低的人群。在癌症风险从高到低转变的人群中，十二指肠溃疡和胃窦非萎缩性胃炎很常见。在癌症风险低的富裕社会中，如西欧、澳大利亚和北美，与低毒力幽门螺杆菌基因型相关的轻度非萎缩性胃炎占主导。胃炎的不同表型可能反映了人类生态的长期变化。
